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Background & objectives: The emergence of drug resistant Candida species has become an important cause of health care associated infections. Antimicrobial resistance is very high in biolm-producing Candida strains. This study was carried out with an aim to study species distribution of Candida isolates among candidemia patients, biolm formation as a virulence factor and their antifungal susceptibility pattern. A total ofMethods: 100 consecutive Candida isolates obtained from blood culture samples were included in the study. Identication of the isolates were done by conventional method and VITEK 2. The antifungal susceptibility were done by VITEK 2 and E test method. Biolm formation was detected using Congo red agar medium, Test tube method and Microtitre plate method. Of the total 100 Candida isolates evaluated, Candida albicansResults: (n=34 isolates) was most common followed by C. tropicalis (n=20 isolates). A larger number of Candida spp. (71%) produced biolm. Biolm production by NAC was signicantly more frequent (75.75%) than that by C. albicans (61.76%). Antifungal resistance rates for Fluconazole (30.98%), Amphotericin B (15.49%) and Flucytosine (11.26%) were higher among the biolm producing strains. All the strains of C. krusei were resistant to Fluconazole and Flucytosine and all strains of C. auris were found resistant to uconazole. Interpretation & Conclusion: Speciation of Candida becomes important as the prevalence of NAC is increasing. Biolm formation exhibits increased resistance to commonly available antifungal therapies. These data has become necessary to reduce the net effect of the increasing severity of Candida infections, drug resistance, and economic burden.

Colonialism in the nineteenth century brought a new ‘space’ for lunatics in British India. The Northeastern province witnessed the establishment of a lunatic asylum in 1876 at Tezpur in present-day Assam. The article explores the historical development of mental health services by the British in this particular region and constructs a history of colonial control of the natives through employing a strict system under the lunatic asylum service. The methods of confinement of inmates, mainly from poor sections of society, and treatment patterns that focussed more on profits and disciplining of inmates, suggest that the asylum was more custodial rather than curative.

Objectives A retrospective study was undertaken to investigate the circulating dengue virus (DENV) serotypes and genotypes in India in 2018. Methods In total, 4963 samples referred to virus research diagnostic laboratories (n=21), the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV) and ICMR-NIV field units (n=2) for diagnosis of dengue in 2018 were tested using a real-time reverse transcription polymerase chain reaction assay for the presence of DENV serotypes. Representative samples were sequenced for the envelope (E) gene. Results Regional diversity was observed with regard to the dominant circulating serotypes. DENV-2 was found to be the most common serotype in many states. Thrombocytopenia, petechiae and malaise were associated with DENV-2 infection. Phylogenetic analyses of DENV E gene sequences revealed the circulation of genotypes I and V of DENV-1, two lineages of DENV-2 genotype IV, DENV-3 genotype III and DENV-4 genotype I. Conclusions This study found regional differences in the prevalence of circulating DENV serotypes in India, and provides baseline data for continuous molecular surveillance. Molecular surveillance may have implications for predicting large-scale outbreaks of dengue if regional shifts in the predominantly circulating serotypes and genotypes are detected during the early phase of the dengue season.

Purpose Hepatitis B virus (HBV) infection is a global health problem. HBV has different genotypes and subgenotypes with geographical distinctiveness. Aims: To study the molecular epidemiology and distribution pattern of HBV in Assam; a distinct state of India that may have different genotypic divergence. Settings and design: Patients attending a tertiary care hospital susceptive of Hepatitis B were included, irrespective of age and sex in different agro-climatic zones of Assam. Methods Samples positive for Hepatitis B surface antigen test and COBAS®TaqMan® HBV tests were further confirmed by PCR and sequencing followed by phylogenetic analysis. Statistical analysis used: Chi-square test was used to determine whether there was a significant difference among the results in this study. Results: An increase trend of HBV positive cases has been observed in the state. The incidence in female was lower than that of male and age group 26–35 years was most vulnerable. Genotype D, subgenotype D2 and serotype ayw3 were predominant genotype, subgenotype and serotype. The prevalence of subgenotype C3 was a new finding. Phylogenetic analysis showed that the genotypes of HBV prevailing in the state have close relationship with neighboring countries of India which may be due to increased cross border migration of population Conclusions This comprehensive study of HBV in Assam described the distribution of HBV genotypes and subgenotypes and serotypes in different agro-climatic zones of Assam. These findings will help to formulate the roadmap for prevention and control of the disease as well as targeted therapy of HBV in this State.

Background and Objectives: Information on the genetic epidemiology of cholera in Assam, a northeastern state of India is lacking despite cholera being a major public health problem. The study aimed to determine the virulence genes and genes encoding antibiotic resistance in Vibrio cholerae isolates and to determine the prevalent genotypes based on the presence or absence of the virulence genes and ctxB genotype. Materials and Methods: Twenty-five V. cholerae strains were subjected to conventional biotyping and serotyping followed by multiplex PCR to detect ctxA, ctxB, zot, ace, O1rfb, tcpA, ompU, ompW, rtxC, hly and toxR and antibiotic resistance genes. Cholera toxin B (ctxB) gene was amplified followed by sequencing. Results: All the V. cholerae O1 isolates were El Tor Ogawa and showed the presence of the core toxin region representing the genome of the filamentous bacteriophage CTXø. The complete cassette of virulence genes was seen in 48% of the isolates which was the predominant genotype. All the isolates possessed amino acid sequences identical to the El Tor ctxB subunit of genotype 3. sulII gene was detected in 68% of the isolates, dfrA1 in 88%, strB in 48% and SXT gene was detected in 36% of the isolates. Conclusion: Toxigenic V. cholerae O1 El Tor Ogawa strains of ctxB genotype 3 carrying a large pool of virulence genes are prevailing in Assam. Presence of a transmissible genetic element SXT in 36% of the strains is of major concern as it indicates the emergence of multiple drug resistance among the V. cholerae isolates.

Influenza virus can cause serious respiratory illness sometimes resulting in epidemics and pandemics associated with significant morbidity and mortality across the globe. Hence, continuous surveillance of the activity of the influenza virus and its subtypes is necessary to help the policy makers to take effective and appropriate decisions regarding its control. The study aimed to determine distribution of influenza viruses in Assam of north-east India having subtropical climate that may lead to viral subtype divergence.Clinically suspected ninety cases with Influenza like illness (ILI) were included, irrespective of age and sex during the period 1st July 2018 to 30th June 2019. Aseptically collected Nasopharyngeal swabs in viral transport media (VTM) were tested by conventional Reverse Transcriptase Polymerase Chain Reaction (RT PCR) for detection of Influenza A and Influenza B viruses which were further processed for detection of subtypes such as H1N1 pdm09, H3N2 and Influenza B (Yamagata and Victoria lineage). Normally distributed continuous variables were summarised by mean and standard deviation. All categorical variables were summarised as percentages.Influenza activity was seen in 42.2% of ILI cases with male predominance (57.9%). Influenza A was the predominant type (84.2%). Among the subtypes, A(H1N1) pdm09 was predominant (76.3%) followed by Influenza B (Victoria lineages) (15.8%) and AH3N2 (7.9%). Significant difference was observed between different subtypes with regard to age distribution only. Influenza activity in Assam showed two seasonal peaks; the primary one from May to July and the secondary from November to February.The study described the distribution of different Influenza viruses and its subtypes in Assam along with their seasonal activities. These findings will help to formulate the policy for its prevention and control in Assam as well as to monitor the efficacy of the current influenza vaccine.

Background The epidemiology, clinical profile and outcome of paediatric candidemia vary considerably by age, healthcare settings and prevalent Candida species. Despite these differences, few comprehensive studies are undertaken. This nationwide study addresses this knowledge gap. Methods 487 children who contracted ICU-acquired candidemia at 23 Indian tertiary care centres were assessed for 398 variables spanning demography, clinical characteristics, microbiology, treatment and outcome. Results Both neonates (5.0 days; range = 3.0-9.5) and non-neonatal children (7.0 days; range = 3.0-13.0) developed candidemia early after ICU admission. Majority of neonates were premature (63.7%) with low birthweight (57.1%). Perinatal asphyxia (7.3%), pneumonia (8.2%), congenital heart disease (8.4%) and invasive procedures were common comorbidities, and antibiotic use (94.1%) was widespread. C tropicalis (24.7%) and C albicans (20.7%) dominated both age groups. Antifungal treatment (66.5%) and removal of central catheters (44.8%) lagged behind. Overall resistance was low; however, emergence of resistant C krusei and C auris needs attention. The 30-day crude mortality was 27.8% (neonates) and 29.4% (non-neonates). Logistic regression identified admission to public sector ICUs (OR = 5.64), mechanical ventilation (OR = 2.82), corticosteroid therapy (OR = 8.89) and antifungal therapy (OR = 0.22) as independent predictors of 30-day crude mortality in neonates. Similarly, admission to public sector ICUs (OR = 3.62), mechanical ventilation (OR = 3.13), exposure to carbapenems (OR = 2.18) and azole antifungal therapy (OR = 0.48) were independent predictors for non-neonates. Conclusions Our findings reveal a distinct epidemiology, including early infection with a different spectrum of Candida species, calling for appropriate intervention strategies to reduce candidemia morbidity and mortality. Independent factors identified in our regression models can help tackle these challenges.

BACKGROUND & OBJECTIVES: An outbreak of respiratory illness of unknown aetiology was reported from Hubei province of Wuhan, People's Republic of China, in December 2019. The outbreak was attributed to a novel coronavirus (CoV), named as severe acute respiratory syndrome (SARS)-CoV-2 and the disease as COVID-19. Within one month, cases were reported from 25 countries. In view of the novel viral strain with reported high morbidity, establishing early countrywide diagnosis to detect imported cases became critical. Here we describe the role of a countrywide network of VRDLs in early diagnosis of COVID-19. METHODS: The Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV), Pune, established screening as well as confirmatory assays for SARS-CoV-2. A total of 13 VRDLs were provided with the E gene screening real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay. VRDLs were selected on the basis of their presence near an international airport/seaport and their past performance. The case definition for testing included all individuals with travel history to Wuhan and symptomatic individuals with travel history to other parts of China. This was later expanded to include symptomatic individuals returning from Singapore, Japan, Hong Kong, Thailand and South Korea. RESULTS: Within a week of standardization of the test at NIV, all VRDLs could initiate testing for SARS-CoV-2. Till February 29, 2020, a total of 2,913 samples were tested. This included both 654 individuals quarantined in the two camps and others fitting within the case definition. The quarantined individuals were tested twice - at days 0 and 14. All tested negative on both occasions. Only three individuals belonging to different districts in Kerala were found to be positive. INTERPRETATION & CONCLUSIONS: Sudden emergence of SARS-CoV-2 and its potential to cause a pandemic posed an unsurmountable challenge to the public health system of India. However, concerted efforts of various arms of the Government of India resulted in a well-coordinated action at each level. India has successfully demonstrated its ability to establish quick diagnosis of SARS-CoV-2 at NIV, Pune, and the testing VRDLs.

As the COVID-19 infection continues to ravage the world, the advent of an efficient as well as the economization of the existing RT-PCR based detection assay essentially can become a blessing in these testing times and significantly help in the management of the pandemic. This study demonstrated an innovative and rapid corroboration of COVID-19 test based on innovative multiplex PCR. An assessment of optimal PCR conditions to simultaneously amplify the SARS-CoV-2 genes E, S and RdRp has been made by fast-conventional and HRM coupled multiplex real-time PCR using the same sets of primers. All variables of practical value were studied by amplifying known target-sequences from ten-fold dilutions of archived positive samples of COVID-19 disease. The multiplexing with newly designed E, S and RdRp primers have shown an efficient amplification of the target region of SARS-CoV-2. A distinct amplification was observed in 37 min using thermal cycler while it took 96 min in HRM coupled real time detection using SYBR green over a wide range of template concentrations. Our findings revealed decent concordance with other commercially available detection kits. This fast HRM coupled multiplex real-time PCR with SYBR green approach offers rapid and sensitive detection of SARS-CoV-2 in a cost-effective manner apart from the added advantage of primer compatibility for use in conventional multiplex PCR. The highly reproducible novel approach can propel extended applicability for developing sustainable commercial product besides providing relief to a resource limited setting.

Northeast India is prone to major earthquake events due to its geographical and tectonic settings. Recurrence of the earthquakes in this part of India is frequent and associated with devastating events. Earthquake scenario in the region is very dangerous as the unplanned settlements with rise in population increased the vulnerability of human life. To understand such a risk and variability in human life and changes in natural dynamics; it is essential to know and study the past earthquake events. In northeast India, the last most devastating earthquake was the great Assam earthquake of 15th August 1950. This event brought different types of changes in the physiography which, results in havoc among the people. The changes in the river course, landslides, liquefaction and river bank changes are most influential factors in both human and natural arrangements. This brought devastation in human lives that resulted into several unsettled socio-economic issues. After the earthquake, Government and people tried together to overcome such trauma, although lack of preparedness caused some problems. This is the time to review all the scenario of major earthquakes in northeast India and realise that the necessity of preparedness is very important. The paper attempts to review the impact of the earthquake on different spheres: geographical, social and economic.

The virus that has posed a serious public health challenge world-wide was pandemic 2009 H1N1 influenza A. This prospective study was undertaken to analyze the clinical profile of 2009 pandemic H1N1 influenza A virus [A (H1N1) pdm 09] infection in patients presenting with influenza like illness from January 2015 to December 2015. A total of 116 respiratory samples were collected from the patients attending the hospitals, which included 71 males and 45 females, ranging in age from one to 79 years. Respiratory specimens were tested for A (H1N1) pdm 09 virus by one step real time reverse transcription polymerase chain reaction. In real-time PCR, the A (H1N1) pdm 09 virus was detected in 14 patients (12.07%) and highest percent of positivity (50.0%) was detected in the age group 25-40 years with the mean age being 40.07 ±4.43 years (SD). Most common presenting symptoms were fever (92.86%) and cough (92.86%) followed by shortness of breath (57.14%), nasal catarrh (50.00%) and sore throat (35.71%). From the study it has been seen that there is prevalence of A (H1N1) pdm 09 virus infection in Assam and thus it needs urgent attention to prevent further spread of the virus in the community. Keywords: Pandemic, Influenza virus, H1N1, Real-time RT-PCR.

Annual outbreaks of acute encephalitis syndrome pose a major health burden in India. Although Japanese encephalitis virus (JEV) accounts for around 15% of reported cases, the aetiology of most cases remains unknown. We aimed to establish an enhanced surveillance network and to use a standardised diagnostic algorithm to conduct a systematic evaluation of acute encephalitis syndrome in India.In this large-scale, systematic surveillance study in India, patients presenting with acute encephalitis syndrome (ie, acute onset of fever with altered mental status, seizure, or both) to any of the 18 participating hospitals across Uttar Pradesh, West Bengal, and Assam were evaluated for JEV (serum and cerebrospinal fluid [CSF] IgM ELISA) per standard of care. In enhanced surveillance, JEV IgM-negative specimens were additionally evaluated for scrub typhus, dengue virus, and West Nile virus by serum IgM ELISA, and for Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, dengue virus, herpes simplex virus, and enterovirus by CSF PCR across five referral laboratories. In 2017, chikungunya and Leptospira serum IgM by ELISA and Zika virus serum and CSF by PCR were also tested.Of 10 107 patients with acute encephalitis syndrome enrolled in enhanced surveillance between Jan 1, 2014, and Dec 31, 2017, 5734 (57·8%) of 9917 participants with available data were male and 6179 (62·7%) of 9856 were children aged 15 years and younger. Among patients who provided a sample of either CSF or serum in enhanced surveillance, an aetiology was identified in 1921 (33·2%) of 5786 patients enrolled between 2014 and 2016 and in 1484 (34·3%) of 4321 patients enrolled in 2017. The most commonly identified aetiologies were JEV (1023 [17·7%] of 5786 patients), scrub typhus (645 [18·5%] of 3489), and dengue virus (161 [5·2%] of 3124). Among participants who provided both CSF and serum specimens, an aetiology was identified in 1446 (38·3%) of 3774 patients enrolled between 2014 and 2016 and in 936 (40·3%) of 2324 enrolled in 2017, representing a 3·1-times increase in the number of patients with acute encephalitis syndrome with an identified aetiology compared with standard care alone (299 [12·9%]; p0·0001).Implementation of a systematic diagnostic algorithm in an enhanced surveillance platform resulted in a 3·1-times increase in identification of the aetiology of acute encephalitis syndrome, besides JEV alone, and highlighted the importance of scrub typhus and dengue virus as important infectious aetiologies in India. These findings have prompted revision of the national testing guidelines for this syndrome across India.US Centers for Disease Control and Prevention.

Background: The purpose of this study was to detect biofilm formation by bacterial isolates from patients with device associated infection admitted in intensive care units (ICUs), to compare the three methods used for detection of bioiflm, to compare the antimicrobial susceptibility pattern of the biofilm producers with the non-producers and to study the risk factors associated with biofilm formation.Methods: A total of 115 bacterial isolates from patients with device associated infection admitted in different ICU for a period of one year was included in the study. These clinical isolates were detected for biofilm formation by tissue culture plate method, tube method and Congo red agar method. Kirby-Bauer disc diffusion method of antibiotic susceptibility was performed on all isolates.Results: Out of the 115 bacterial isolates, 71 were biofilm producers. Tissue culture plate method detected the maximum number of biofilm producers (61.7%). The maximum number of biofilm producers were isolated from tracheal aspirate and endotracheal tubes (52.1%) followed by blood (17%) and urine (12.6%) respectively. The predominant biofilm producing isolates were Klebsiella pneumoniae (39.4%), Staphylococcus aureus (19.7%) and Pseudomonas aeruginosa (16.9%). Multi drug resistance among the biofilm producers was significantly higher than the non-biofilm producers (p value=0.0125). The risk of biofilm formation was seen to increase with the increase in duration of hospital stay (p value=0.0092, statistically very significant).Conclusions: From this study it was found that a high degree of biofilm producers were isolated from patients on indwelling devices. Tissue culture plate was found to be the most accurate method. The degree of multidrug resistance among the bioiflm producers was significantly higher than the non-producers.

Mycetoma is a slowly progressive, chronic granulomatous infection of skin and subcutaneous tissue caused by traumatic inoculation of either fungi (eumycotic) or bacteria (actinomycotic). The disease is characterized by triad of tumefaction, discharging sinuses and grains. Here, we report a case of eumycetoma in an infant presenting with multiple discharging sinuses in lower limb. Aspirate and biopsy tissue from the sinuses were processed. The discharge revealed presence of white grains. Potassium hydroxide (KOH) mount revealed presence of hyaline septate hyphae. Histopathological examination showed granulation tissue and fungal hyphae. Repeated culture on sabouraud’s dextrose agar (SDA) with chloramphenicol showed growth of Aspergillus flavus on each occasion. Antifungal susceptibility testing was done following Clinical Laboratory Standard Institute (CLSI) M38-A2 protocol and showed high minimum inhibitory concentration (MIC) for fluconazole, caspofungin, anidulofungin and micafungin. The patient responded to itraconazole. Hence, exact categorization of lesion is essential for effective therapy and better prognosis.

Background: Superficial mycosis is the commonest infections affecting human globally. Though they do not cause mortality, their clinical significance lies in their morbidity, recurrence, and cosmetic disfigurement, thus creating a major public health problem. The infections are more prevalent in the tropical regions. The etiological agents are also seen to vary with time and geographical location. Aim: This study was carried out to find out the trend of superficial mycosis in Assam, along with a clinicomycological correlation. Materials and Methods: A total of 130 clinically diagnosed cases of superficial mycoses attending the outpatient department (OPD) of a tertiary hospital in Assam for a period of 1 year were taken up for the study. After taking the informed consent and a proper history, the clinical materials like skin scrapings, nail clippings, and infected hair were sent for mycological examination. Results: The infection was found to be more prevalent among males than females (M:F, 3:2) and among the farmers and laborers (24.61%). Tinea corporis was the commonest clinical type (21.5%). Among the fungal isolates, dermatophytes were the most frequent isolates (43.54%), out of which Trichophyton rubrum was commonest. nondermatophyte moulds like Fusarium, Aspergillus, Scopulariopsis, Trichosporon, and Penicillium spp. were isolated. Conclusion: The epidemiology of fungal infection and the causative fungi is seen to vary geographically and with time. This study reflects the changing trend of fungal infection in the north eastern region with a high rate of isolation of nondermatophyte moulds as the causative agent.

Talaromycosis is an opportunistic infection caused by a dimorphic fungus, Talaromyces marneffei. We describe here a case of 38 years old HIV seropositive male patient from Assam presented with fever, cough, weight loss and discrete, multiple, umbilicated papules and nodules in face and upper trunk. Differential diagnosis of histoplasmosis, giant molluscum contagiosum and talaromycosis were considered. Histopathological and mycological study of skin biopsy tissue confirmed the diagnosis of talaromycosis. Primary treatment with amphotericin B and itraconazole showed promising results. Early diagnosis and adequate antifungal therapy are imperative to avoid the complications. Talaromyces requires further in-depth study with respect to its global distribution, natural history, pathogenesis and the impact of antiretroviral therapy.

Background & objectives: Although cholera remains to be an important public health problem, studies on reliable population-based estimates of laboratory confirmed cholera in endemic areas are limited worldwide. The aim of this hospital-based study was to evaluate the prevalence of Vibrio cholerae serogroup in Assam, India, during 2003-2013. Methods: Stool samples/rectal swabs were collected from acute watery diarrhoea (AWD) cases during 2003-2013 and processed by standard microbiological procedures. Antibiotic sensitivity test was done following the Clinical and Laboratory Standards Institute guidelines. Year-wise epidemiological trend of cholera was analyzed. Results: Cholera contributed to 3.93 per cent of AWD cases. In Assam, cholera was found to be more prevalent in the rural areas (6.7%) followed by the tea gardens (5.06%), urban slum (1.9%) and urban areas (1.4%). Highest proportion of cholera (13.7%) was observed in 0-10 yr age group. Of them, 11.5 per cent belonged to 0-5 yr age group. V. cholerae O1 El Tor serotype Ogawa was the predominant isolate. Multiple drug-resistant isolates of V. cholerae O1 Ogawa were reported in the study. Interpretation & conclusions: Emergence of resistance amongst V. cholerae towards many antibiotics is a matter of concern. Hence, continuous surveillance for diarrhoeal disorders is necessary to control the future outbreaks of cholera in this region.

Background: The present study was undertaken to investigate the trend of JE and the different parameters associated with it.Methods: It was a hospital-based retrospective study conducted from January 2014 to December 2017. A total of 3531 consecutive non-repetitive patients, satisfying the clinical case definition of AES as per the WHO guidelines, were included in the study. Cerebrospinal fluid (CSF) and serum samples were tested for JEV-specific IgM antibodies by the NIV JE IgM Capture ELISA Kit.Results: Of the 3531 patients admitted, 838(23.7%) cases were positive for JE IgM antibodies. There was a significant reduction in the JE positivity rate from 32.9% in 2014 to 13.3% in 2017. The male-to-female ratio was 1.6:1. JE positivity rate was significantly higher in adults as compared to children. The majority of cases occurred during the monsoon and post-monsoon season. Fever (100%), change in mental status (87.8%), headache (70.5%), neck rigidity (32.4%), unconsciousness (35.4%), seizure (43.9%) and paralysis (5%) were the major clinical symptoms. JE positivity was seen to be higher in the rural areas of Assam.Conclusions: A declining trend of JE was seen in this study, however further research work needs to be done to look for non-JE causes of AES.

Background: Onychomycosis (OM) is a common nail disorder caused by dermatophytes, non-dermatophyte moulds and yeasts. The increased prevalence of OM along with the wide range of associated fungi necessitates the accurate labora­tory isolation and identification of the causative fungus for optimal management strategies. The aim of the study was to evaluate clinical, epidemiological and mycological characteristics of OM in a tertiary care hospital in Assam.Methods: It was a prospective hospital-based study. Hundred consecutive patients clinically diagnosed as OM were subjected to detailed history, clinical examination and investigations. Nail clipping and subungual debris of OM patients were subjected to KOH preparation and culture. Isolates were identified by colony characters, pigment production, microscopic morphology and biochemical tests.Results: The maximum number of OM cases belonged to the age group 21-30 years with a male preponderance (M:F=1.7:1). The commonest clinical type of OM was distal lateral subungual onychomycosis (DLSO) (51%). Toe nails OM was the most common presentation (54%). Trauma (35%) was the most common predisposing factor. Farmers (agro industry labourers) (23%) were found to be the most commonly affected group. Non-dermatophyte moulds (NDM) accounted for 38(47.5%) of OM cases followed by yeast 27(33.8%) and dermatophytes 15(18.8%).Conclusions: Early diagnosis and treatment is important to prevent distortion of the nails which can prevent loss of working efficiency of the commonly affected population of this region.

We report here a case of human ocular thelaziasis that was discovered accidentally during cataract surgery. A 58-year-old farmer attended an eye camp for diminished vision of the left eye, which was diagnosed later on as cataract. He was referred to a tertiary care hospital in Assam. During the cataract surgery, two small, motile, chalky white, translucent worms were removed from the left fornix. They were identified as female Thelazia callipaeda. Rare occurrence of this disease and its association with both extra and intraocular manifestations leading to ocular morbidity is the rationale for presenting this case.

Staphylococcal scalded skin syndrome (SSSS) or acute staphylococcal epidermolysis is an exfoliative skin disease and a toxin mediated staphylococcal infection affecting mostly neonates and adolescents. We describe here a case of 10-day old full term, vaginally delivered baby weighing 1530gms presenting with erythematous lesions first developing on the face and later spreading to the entire body for the last 6 days. The mucosal areas were spared. Blood culture of the patient revealed growth of Methicllin Resistant Staphylococcus aureus (MRSA). Culture from the skin lesions also revealed growth of MRSA with similar antibiotic sensitivity pattern. Fungal culture from the skin lesions revealed growth of Candida tropicalis. The diagnosis of SSSS was based on clinical criteria and microbiological findings.

A systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India. A prospective, nationwide, multicentric, observational study was conducted at 27 Indian ICUs. Consecutive patients who acquired candidemia after ICU admission were enrolled during April 2011 through September 2012. Clinical and laboratory variables of these patients were recorded. The present study is an analysis of data specific for adult patients. Among 1,400 ICU-acquired candidemia cases (overall incidence of 6.51 cases/1,000 ICU admission), 65.2 % were adult. Though the study confirmed the already known risk factors for candidemia, the acquisition occurred early after admission to ICU (median 8 days; interquartile range 4–15 days), even infecting patients with lower APACHE II score at admission (median 17.0; mean ± SD 17.2 ± 5.9; interquartile range 14–20). The important finding of the study was the vast spectrum of agents (31 Candida species) causing candidemia and a high rate of isolation of Candida tropicalis (41.6 %). Azole and multidrug resistance were seen in 11.8 and 1.9 % of isolates. Public sector hospitals reported a significantly higher presence of the relatively resistant C. auris (8.2 vs. 3.9 %; p = 0.008) and C. rugosa (5.6 vs. 1.5 %; p = 0.001). The 30-day crude and attributable mortality rates of candidemia patients were 44.7 and 19.6 %, respectively. Logistic regression analysis revealed significant independent predictors of mortality including admission to public sector hospital, APACHE II score at admission, underlying renal failure, central venous catheterization and steroid therapy. The study highlighted a high burden of candidemia in Indian ICUs, early onset after ICU admission, higher risk despite less severe physiology score at admission and a vast spectrum of agents causing the disease with predominance of C. tropicalis.

Objective : To define the spectrum of zygomycosis due to mucorales in an Indian scenario. Methods : One-hundred and twenty-nine patients with zygomycosis due to mucorales diagnosed at the Postgraduate Institute of Medical Education and Research, Chandigarh, India during 1990–99, were retrospectively analysed regarding the sites of involvement, underlying disease, species of fungi isolated and outcome of therapy. Results : Higher prevalence rate (19.4%) was observed in 1999. Rhino-orbito-cerebral type (44.2%) was the commonest presentation followed by cutaneous (15.5%) and renal (14.0%) involvement. Disseminated zygomycosis was seen in 11.6% patients. Pulmonary and gastrointestinal zygomycosis were diagnosed in 10.1% and 4.7% patients, respectively. Uncontrolled diabetes mellitus (in 50% of cases) was the significant risk factor in rhino-orbito-cerebral type [odds ratio (OR), 9.3; P ≤0.001) and breach of skin (in 40% cases) in cutaneous zygomycosis (OR, 6.9; P ≤0.01). However, a considerable number of 22 (22.9%) patients were apparently healthy hosts in this series. Forty-five patients (34.9%) of this series were diagnosed only at post-mortem. Among 47 patients where culture was attempted, mucorales were isolated from 25 patients with Rhizopus arrhizus (11 patients) and Apophysomyces elegans (eight patients) as the predominant isolates. Adequate therapy could be provided in 33 patients. A combination of aggressive surgical debridement of necrotic tissue and amphotericin-B was found to be the best treatment protocol as 81.3% patients treated with surgical debridement and amphotericin-B were cured, compared with 46.7% patients treated with amphotericin-B alone. Conclusion : The study highlights the importance of increased awareness for early diagnosis of zygomycosis and aggressive management. The large number of cases in apparently healthy hosts and increased isolation of A. elegans in the present series are important characteristics of this disease in India and requires further evaluation.

The optical properties of high quality single crystal epitaxial zinc oxide thin films grown by pulsed laser deposition on c-plane sapphire substrates were studied. It was found that annealing the films in oxygen dramatically improved the optical and electrical properties. The absorption coefficient, band gap, and exciton binding energies were determined by transmission measurements and photoluminescence. In both the annealed and the as-deposited films excitonic absorption features were observed at both room temperature and 77 K. In the annealed films the excitonic absorption peaks were substantially sharper and deep level photoluminescence was suppressed.

We present a case of cutaneous hyalohyphomycosis due to Acremonium strictum in an immunocompetent individual along with an overview of fungal infections caused by A. strictum. The diagnosis was confirmed by the presence of hyphae in microscopic examination of cutaneous biopsy and discharge, positive culture for A. strictum and sequencing of the isolate at reference centre. The infection resolved with itraconazole and terbinafine. Cutaneous or subcutaneous infections of A. strictum have rarely been reported. Fungemia or disseminated infection often with fatal outcome in immunocompromised patients was the most common presentation of A. strictum infection found in the literatures. The studies also reveal worldwide variation in the treatment regime and outcome of the treatment.

Background: Geographical variation in the distribution of Malassezia species associated with pityriasis versicolor (PV) has led to the necessity of studying epidemiological, mycological, and clinical characteristics of PV. Aims: To study the epidemiological, mycological, and clinical characteristics of PV in a tertiary care hospital. Settings and Design: The study was carried out with a cross-sectional design. Materials and Methods: Two hundred and sixty-two consecutive PV patients were subjected to detailed history, clinical examination, and investigations. Skin scrapings were processed by direct microscopy and culture. Isolates were identified by phenotypic characteristics and polymerase chain reaction-restriction fragment length polymorphism. Association of Malassezia species with clinical and epidemiological characteristics was studied. Statistical analysis of the data was done using statistical software. Results: Maximum number of PV cases (33.9%) belonged to the age group of 21–30 years with a male preponderance. 61.4% of the patients had a sedentary lifestyle, 70.2% showed the gradual onset of the disease, 51.1% presented with pruritus and in 66.4% of the patients symptoms were continuous. Most commonly involved body site was neck (27.8%), 77.09% of the lesions were bilaterally asymmetrical, 87.4% were macular, and 89.3% were hypopigmented. Malassezia furfur (77.3%) was the predominant species. Sedentary lifestyle (61.4%) and increased sweating (48%) were the most commonly associated predisposing factors. Conclusion: PV is more common in males. Distribution of Malassezia species varies significantly from those reported in other parts of India. M. furfur was the most common species responsible for PV in our region. Hence, further studies are required to evaluate the exact cause of this variation.

Onchocerca volvulus is a spirurid nematode that mainly affects the rural poor of Sub-Saharan Africa, Yemen and parts of Central and South Africa. River blindness, caused by Onchocerca volvulus, is considered to be the second commonest infectious cause of blindness worldwide. We report a rare case of ocular onchocerciasis where a live adult worm was extracted from the eye of a patient from a nonendemic region. The worm was identified as Onchocerca volvulus based on morphological features. The patient was treated with Ivermectin (0.2 mg/kg). At six months follow-up she had complete remission of symptoms.

Chromoblastomycosis is a chronic fungal infection caused by several pigmented fungi commonly seen in tropical and sub-tropical climate. We report here two cases of chromoblastomycosis from the tea gardens of Assam, a state in the north-eastern region of India having a subtropical climate. Of the two patients, one presented with extensive lesions covering a large area of the body and gave a past history of thorn prick in his right foot. The laboratory diagnosis was done by direct microscopy and culture of skin scraping and biopsy tissue and the isolate was identified as Cladophialophora carrionii. On contrary to the fact that Chromoblastomycosis is known for its slow spread and chronic nature, a rapid spread of the disease within a short span of 8 months was noticed in this case affecting the livelihood of the patient. To best of our knowledge, this is the first report of chromoblastomycosis caused by Cladophialophora carrionii from Assam. In the second patient, a large cauliflower like mass in the leg was the presenting feature. Diagnosis was confirmed by microscopy and culture of the biopsy tissue. Fonsecaea pedrosoi was isolated from this case. Both the patients were treated with Fluconazole and showed slight improvement with decrease in size of the lesions after 1 month.

The optical and structural properties of high-quality single-crystal epitaxial MgZnO films deposited by pulsed-laser deposition were studied. In films with up to ∼36 at. % Mg incorporation, we have observed intense ultraviolet band edge photoluminescence at room temperature and 77 K. The highly efficient photoluminescence is indicative of the excitonic nature of the material. Transmission spectroscopy was used to show that the excitonic structure of the alloys was clearly visible at room temperature. High-resolution transmission electron microscopy, x-ray diffraction, and Rutherford backscattering spectroscopy/ion channeling were used to verify the epitaxial single-crystal quality of the films and characterize the defect content. Post-deposition annealing in oxygen was found to reduce the number of defects and to improve the optical properties of the films. These results indicate that MgZnO alloys have potential applications in a variety of optoelectronic devices.

Primary cytomegalovirus infection is the most common infection during pregnancy that may have long-term neurodevelopmental sequelae in children born to these mothers. It is also associated with many obstetric complications. So the aim of this study was to determine the seroprevalence of cytomegalovirus infection in local antenatal population with bad obstetric history and to see the effects, if any, of age, socio-economic status, presenting features and different gestational periods. Seventy-five pregnant women with bad obstetric history were screened for the presence of cytomegalovirus specific IgM and IgG antibodies by doing enzyme-linked immunosorbent assay, out of which 17(22.66%) had evidence of recurrent cytomegalovirus infection as demonstrated by the presence of cytomegalovirus specific IgM antibodies. All were found to be positive for cytomegalovirus specific IgG antibodies. This indicates that the presence of cytomegalovirus specific IgM antibodies in this population is an evidence of reactivation of a latent infection or re-infection with a different strain of cytomegalovirus. Increased IgM seropositivity was found to be associated with advancing age, poor, socio-economic status, third trimester of pregnancy and bad obstetric history like premature delivery, stillbirth, recurrent spontaneous abortions, intra-uterine growth retardation. Out of 25 randomly selected non-pregnant women of childbearing age, all showed presence of cytomegalovirus specific IgG antibodies and none was found to be positive for primary or recurrent cytomegalovirus infection.

Cutaneous larva migrans (CLM) or creeping eruption (also called ground itch) refers to the production of serpiginous inflammed trails in the skin, resulting in intense pruritus. It is an uncommon parasitic skin infection caused by larvae of various nonhuman species of Ancylostoma and other nematodes. Human can pick up the infection by walking barefoot on soil or sandy beaches contaminated with animal faeces. Here, we report a case of cutaneous larva migrans affecting the whole trunk in a 65 year old man who is a farmer by occupation. The diagnosis was made on the basis of clinical features and biopsy of the skin. Erythematous, serpiginous, pruritic, cutaneous eruptions were found. A nematode larva could be detected in the vesicular fluid and histopathological examination of skin showed superficial and mid perivascular and interstitial infiltrate of numerous eosinophils constituent with larva migrans. Though CLM is a self limited dermatosis, the discomfort caused due to intense pruritus, eczematization and the risk for secondary bacterial infection necessitate treatment of the cases.

Fungemia is usually nosocomial and develops in the setting of antimicrobial therapy, cancer chemotherapy, bowel surgery or the use of intravenous plastic catheters. Here we report a case of intravenous catheter associated fungemia caused by Candida rugosa. Multiple samples of blood and catheter tip were cultured on Blood Agar, Sabouraud's Dextrose Agar media. Morphology was studied on Corn Meal Agar and HiChrome Candida Differential Agar. The isolate was further confirmed by biochemical tests and Mini API (bioMerieux, Etoile, France). The strain was also confirmed by molecular analysis in reference centre. Antifungal susceptibility test was done following M-44A Clinical and Laboratory Standard Institute (CLSI) guidelines. The isolate was labeled as Candida rugosa. The isolate was sensitive to nystatin and itraconazole. The patient expired subsequently despite antifungal therapy. Candida rugosa may represent an emerging pathogen associated with invasive medical procedures causing serious systemic infection and associated with high mortality rates.