Concurrent mycetoma and chromomycosis.

Chromoblastomycosis and Madura foot are chronic localised mycotic infection of the skin and subcutaneous tissue that follows the implantation of the fungi through minor trauma, mainly found in persons working outdoors on bare foot. In cases where both Madura and chromoblastomycosis are present, the treatment becomes difficult with low cure rates and frequent relapses. Here, we present such a very rare case of a 38-year-old cattle farmer who presented with verrucose nodules, tumefaction and multiple discharging nodules on the left lower 1/3 rd leg and foot since last 9 years. Direct KOH mount of the verrucose tissue showed Fonsecaea pedrosoi sclerotic muriform bodies and a biopsy of one granule discharging nodule demonstrated fungal mycetoma. He was put on tab. Itraconazole 200 mg o.d. and cotrimoxazole bid for 6 months with very little improvement. The rarity of this combination is most probably due to different geographical distribution.

A test of the catecholamines hypothesis for an acute exercise-cognition interaction.

The purpose of the study was to examine the usage of norepinephrine (NE) and dopamine (DA) in the brain when exercising while simultaneously undertaking cognitive tests. Plasma concentrations of the NE metabolite 3-methoxy 4-hydroxyphenylglycol (MHPG) and the DA metabolite homovanillic acid (HVA) showed a linear increase from rest to exercising at 40% and 80% maximum power output (W.max) while simultaneously undertaking cognitive tasks (random number generation (RNG) and response time). Delta plasma concentrations of MHPG and HVA at each exercise intensity while undertaking cognitive tasks and while exercising without cognitive tasks did not differ. Taking blood samples at 0, 1, 3, and 5 min following cessation of exercise did not affect results. Regression correlations showed that delta MHPG and HVA plasma concentrations at the 1 and 3 min sampling times were strong predictors of delta RNG, response time and movement time. Reaction time at 80% W.max significantly increased, while movement time at 80% W.max significantly decreased. It was concluded that these results provide no support for a direct effect of increased catecholamines concentrations on cognitive performance during exercise. The regression data suggest that there is some relationship between exercise, catecholamines concentrations and cognition.

Necrotic erythema nodosum leprosum with oral mucosal involvement.

Leprosy is a chronic, infectious disease with varied clinical presentations. The type 2 lepra reaction / erythema nodosum leprosum (ENL) classically involves extremities and face. Besides to the classical lesions of type 2 lepra reaction sometimes rare findings of vesicular lesions with necroticans may be observed. We are reporting a case of lepromatous leprosy with bullous reaction and necroticans involving usual sites along with the unusual involvement of oral cavity, which on first look mimicked necrotizing vasculitis or other bullous disorders. This manifestation of type 2 lepra reaction in oral mucosa should be kept in mind by the physicians while dealing with a case of type 2 lepra reaction.

Fnac study of histoid nodule: an early tool for diagnosis.

Histoid lesion, a variety of lepromatous leprosy, is due to alteration in the growth pattern of Mycobacterium leprae, possibly due to loss of immunity in localized areas. The distinction is based on cellular morphology by demonstrating pallisading arrangement of multi-layered spindle-shaped histocytes. Cytodiagnosis by fine needle aspiration cytology is therefore an early tool to recognize the histoid variety, differentiating it from a conventional LL module, as it is a simple and less traumatic procedure.

Prevalence of leprosy among household contacts of leprosy cases in western Orissa.

The prevalence rate of leprosy among household contacts is an important epidemiological indicator in the character and trend of the disease. During the period January 2001 to December 2002, families of 400 primary cases were studied to detect contact (secondary) cases. Seventy-two cases were detected from 54 families; of these 72 cases, 45 (62.5%) were in the paediatric age-group (0-14 years) and of these 45.8% belonged to 6-14 years group. Out of the 72 cases, there were more (58) of paucibacillary (PNL+I+TT+BT) cases. Secondary cases were significantly high when there was lepromatous type of leprosy in the family. The attack rate among those exposed to paucibacillary type (TT, BT) of leprosy, though much less, was still observed. The influence of duration of contact revealed that a maximum number of cases (N=43, 59.7%) acquired the disease during 0-6 years of contact. A majority of the patients belonged to low-income groups, were illiterate and lived in extended families. The father was the source case for most of the secondary cases (N=41, 57%). Conjugal leprosy was very rare. The results of the study points to the fact that PB leprosy is still a potential source of infection and cannot be ignored. It is important to evolve a hospital-based surveillance programme for contacts of leprosy patients since early detection and treatment of contacts are important measures for reducing the reservoir of infection in the community.