Search

An outbreak of acute hemorrhagic conjunctivitis occurred in Delhi, India, during August and September 1996, The etiologic agent was confirmed as enterovirus type 70 by a modified centrifugation-enhanced culture method [...]

The first major dengue outbreak in Delhi, India, is discussed. The outbreak of dengue hemorrhagic fever/dengue shock syndrome (DHS/DSS) was in 1996 in and near Delhi. The cause was seen to be dengue virus type 2. It was the largest such outbreak reported from India and showed serious resurgence of dengue virus infection. There is a seasonal pattern. All outbreaks are during the monsoon season, Aug-Nov. Table lists age distribution of those with culture-positive dengue., An outbreak of dengue hemorrhagic fever/dengue shock syndrome (DHS/DSS) occurred in 1996 in India in and near Delhi. The cause was confirmed as dengue virus type 2, by virus cultivation [...]

Background: Fungal infection of the nails is a common, difficult to treat problem, prevalent worldwide. A discrepancy in the microscopic examination and culture findings can create problems in the diagnosis of this common infection. Aim: This study was designed to evaluate a new method for accurate diagnosis of onychomycosis. Materials and Methods: Nail samples from 25 patients of suspected onychomycosis were taken. A portion of the samples was treated with 2% trypsin before culturing and the rest was processed by the standard mycological technique. Results: A higher number of culture positive samples were obtained by the trypsin treatment method as compared to the standard technique. Conclusion: Trypsin treatment prior to culture increases the isolation of fungi from nail samples.

Introduction: Panniculitis may result due to various etiologies. In post-transplant immunosuppressed patients infection is the foremost cause of panniculitis. We present two cases of fungal panniculitis in renal transplant recipients. Case Reports: CASE 1: A 33 year old male patient who had been transplanted 13 years earlier presented with erythematous nontender plaques on left thigh. He was already in CAN with sr treat. 6.0 mg%. Deep skin biopsy revealed panniculitis with cryptococci. He also had cryptococcal pneumonitis and UTI. He was treated with amphotericin B (total dose 2g). The lesions resolved completely. Renal function remained stable. One year later he was retransplanted and is doing well. Case 2: A 22 year old male developed pyrexia of unknown origin six months post transplant. Bone marrow examination revealed histoplasmosis. He was treated with amphotericin B (total dose 1 gm). Three months later he developed multiple subcutaneous nodules on the trunk and tight thigh. Incisional biopsy of one of the nodule revealed panniculitis with histoplasma in macrophages. He was treated with amphotericin (total dose 2.5g). Itraconazole 200 rag/day was added with the advise to continue it for one year. He is doing well with normal renal functions. Conclusion: Cutaneous lesions may be the only sign of serious systemic disease in post-transplant immunosuppressed patients, as seen in both the patients described above. Transplant physicians need to be aware of this presentation as appropriate timely investigations and optimal treatment is associated with good outcome. [ABSTRACT FROM AUTHOR]

A fifteen-year-old boy was brought to emergency department with complaints of altered sensorium, aphasia and right sided hemiparesis following severe dengue one month back. On physical examination, tone was flaccid and power was diminished in right upper and lower limbs. Reflexes were diminished in all four limbs. Magnetic resonance imaging showed multiple well defined thin walled ring-enhancing lesions in left basal ganglia, bilateral cerebellum, left occipital lobe and bilateral fronto-temporo-parietal lobes. The basal ganglia focus was tapped. Potassium hydroxide-calcofluor white mount of the intra-operative pus sample showed fragmented septate hyphae with folding and with wide variations in breadth. A provisional report of septate and aseptate hyphae suggestive of mixed infection was given. Empirical voriconazole was stopped and the patient was started on liposomal amphotericin B to cover a broader spectrum of molds. Subsequently, fungal culture of the pus sample grew off-white glabrous colonies in multiple culture tubes. On lactophenol cotton blue mount, shield cells were seen suggestive of Cladosporium spp. Amphotericin B was stopped after provisional identification of Cladosporium spp. was given by the laboratory and IV voriconazole was started. The identification was confirmed to be Cladosporium cladosporioides by microculture and sequencing of the internal transcribed spacer region of the 18s ribosomal DNA. The patient improved with drainage of the largest basal ganglia focus and voriconazole. This case exemplifies the potential of saprobic fungi to cause invasive infections in human., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Masson SAS.)

Owing to their inherent resistance to different classes of antifungals, early identification of Fusarium spp. is crucial. In this study, 10 clinical isolates were included from patients with invasive fusariosis involving lungs, sinuses, or both. Clinico-radiological data were collected. Samples were processed by standard laboratory procedures. Three gene regions (ITS, TEF1, and RPB2) were amplified by PCR for multilocus sequencing. Fusarium MLST, FUSARIUM-ID, and FUSARIOID-ID databases were used for final identification. Antifungal susceptibility testing was performed by broth microdilution following CLSI M38-A3 and Sensititre™ YeastOne™ YO9 plate. Pulmonary involvement was seen in all patients, and sino-nasal involvement was present in six. Radiologically, consolidations and cavitations were present in eight and six cases, respectively. Halo sign was present in six; reverse halo sign was also found in three of them. Direct microscopy showed septate hyphae that were morphologically different from those found in aspergillosis. Results of the molecular identification were as follows: two Fusarium irregulare, one Fusarium pernambucanum, one Fusarium incarnatum, one Fusarium sp. FIESC 30, two Fusarium keratoplasticum, one Fusarium falciforme, one Fusarium pseudonygamai, and one Fusarium delphinoides. For both Fusarium solani (FSSC) and Fusarium incarnatum-equiseti (FIESC) species complexes, amphotericin B had the lowest minimum inhibitory concentrations (MICs). Importantly, for terbinafine, all FIESC isolates had low MICs, while FSSC isolates had high MICs. In some cases, early identification of Fusarium spp. is possible by means of morphology of hyphae on direct microscopy and findings on radiology. Molecular identification, at least to the species complex level, is crucial for the choice of antifungals., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)

The complete genome assembly of Candida auris strains B11103, B11221, and B11244 is reported in this manuscript. These strains represent the three geographical clades, namely, South Asian (Clade I), South African (Clade III), and South American (Clade IV)., Competing Interests: The authors declare no conflict of interest.

Objective: MALDI-TOF-MS facilitates the identification of microorganisms from positive cultures in a timely and accurate manner. It eliminates the necessity for the application of biochemicals and operates on the principle of proteomics. It decreases the time required to report culture results. Prompt detection and notification of the pathogen, prior to the disclosure of antimicrobial susceptibilities, could potentially shorten the duration until the initial antibiotic adjustment is necessary, thereby influencing patients' clinical prognoses., Methodology: Fifty patients in the conventional arm and one hundred patients in the interventional arm were compared in a pre and post quasi-experimental study conducted at a tertiary care centre in North India. Patients with positive cultures from medical wards and intensive care units were included. Comparing the time to first antibiotic modification after culture positivity, MALDI-TOF-MS-based identification, and clinical outcomes in both arms was the primary objective. Antibiotic modifications, escalation, and de-escalation were all recorded., Results: The intervention arm exhibited a substantially shorter median time to first antibiotic modification (2010 mins vs 2905 mins, p=0.002) than the conventional arm. In the interventional group, a total of 44 out of 100 antibiotic modifications were implemented. Of these, 19 (43.3%) were determined solely by the MALDI report, without the anticipation of susceptibility assessments. De-escalation of antibiotics constituted the pre-dominant form of modification (47.4%). The difference between the 27% and 32% mortality rates in the intervention arm and the conventional arm was not statistically significant (p=0.52)., Conclusion: MALDI-TOF-MS facilitates the modification of antibiotics early on. The primary benefit lies in the reduction of superfluous antibiotic usage. Early organism identification and reporting prior to the availability of susceptibility results did not result in any mortality benefit. This strategy, when combined with a strong antimicrobial stewardship programme, can aid in the reduction of antibiotic use., Competing Interests: Conflict of interest: The authors declare no conflict of interest.