Clinico-mycological profile of onychomycosis in Assam, India

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

To study the pattern of suspected adverse drug reactions in patients coming to the department of dermatology in Gauhati Medical College and Hospital, Guwahati, Assam, India

Background: Cutaneous adverse drug reactions (ADRs) are the commonest ADRs (30-45%) and are responsible for about 2% of hospital admissions. This study was conducted to study the pattern of ADRs coming to the department of dermatology in a Tertiary Health Care Hospital. The objectives of the study were to assess the causality, severity, preventability, age distribution, sex distribution and the reactions occurring.Methods: Cross-sectional study. The suspected adverse drug reactions (ADRs) reported from the department of dermatology in the Spontaneous ADR reporting form was analysed in this study over a period of one year.Results: A total of 513 cases of reported ADRs were analysed. The highest number of ADRs was reported in the Age group 21-40 years with female preponderance. Erythematous maculopapular lesions were the most common ADR and maximum cases of ADRs were observed with steroids. Most cases were found to be probable (causality assessment), of mild severity and were probably preventable.Conclusions: The study showed that a number of drugs cause dermatological ADRs. These ADRs vary in their appearance, duration, causality, severity, and preventability

A study on adverse drug reactions in a tertiary care hospital of Northeast India

Objective: Purpose of this study was to monitor adverse drug reactions reported from various departments of a tertiary care hospital in Northeast India. Reported adverse drug reactions were analysed for causality and severity assessment.Methods: This cross sectional study was conducted in a tertiary care hospital at Guwahati, Northeast India, for 7 months. Patients of all age and either sex were included. Adverse drug reactions were reported by the physicians of this hospital and their causality and severity assessments were performed as per Naranjo’s and Hartwig’s assessment criteria respectively. Descriptive statistics were used for data analysis.Results: Total 255 adverse drug reactions were reported from various departments of this tertiary care hospital. Most of the adverse drug reactions were observed in the age group of 21–30 year. Acne (46) was commonly reported reaction. Topical steroids, betamethasone sodium phosphate and clobetasol were reported to induce maximum number of reactions (59). Skin (227, 66.9%) was commonly affected organ system. Most of the adverse drug reactions were possible (240, 94.1%) and mild (222, 87%) in nature.Conclusions: The topical steroid (betamethasone sodium phosphate) was reported to induce adverse drug reactions in majority of the patients. The commonly reported reaction was acne.Keywords: ADRs; Northeast; Naranjo; Hartwig; Pharmacovigilanc

Generalized pustular psoriasis of pregnancy successfully treated with cyclosporine

Two multigravidae aged 27 and 29 years, with previous uneventful pregnancies, second being psoriatic, reported at 24 and 28 weeks of pregnancies, with generalized pustular lesions. Laboratory findings, including serum calcium were normal. Ultrasonography showed normal fetal growth. Histopathology confirmed pustular psoriasis. Patients were put on cyclosporine 3 mg/ kg weight/ day after failure of an initial systemic steroid. Blood pressure, pulse, and fetal heart sounds were recorded every 12 hours, and ultrasonography and blood parameters, biweekly. Cyclosporine was tapered and stopped after delivery of two healthy babies at 38 weeks. We conclude that cyclosporine can be an option in the management of pustular psoriasis of pregnancy or psoriasis with pustulation in pregnancy

Atypical cutaneous lesions of Penicillium marneffei infection as a manifestation of the immune reconstitution inflammatory syndrome after highly active antiretroviral therapy

Penicillium marneffei infections normally manifest as molluscum contagiosum like skin lesion in HIV-infected persons. We report a case with verrucous lesions over nose and face due to Penicillium marneffei infection after HAART treatment. A 28-year-old man presented, after two weeks of HAART treatment, with multiple erythematous, scaly, papules and nodules with central necrosis predominantly in face and both extremities and scrotum. Microbiological investigations confirmed the diagnosis of Penicillium marneffei infection. This is perhaps the first case report with such manifestation due to Penicillium marneffei infection

Clinicomycological profile of pityriasis versicolor in Assam

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

White Grain Eumycetoma due to Aspergillus flavus in Infancy: A Rare Case Report from Assam

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

A Clinicopathological Study of Cutaneous Tuberculosis at Dibrugarh District, Assam

Background: Cutaneous tuberculosis forms a small subset of extra pulmonary tuberculosis and has a worldwide distribution. Aims: The present study is an attempt to find out the incidence, clinical spectrum, and histopathological features of cutaneous tuberculosis. Materials and Methods: A total of 42 cases of newly diagnosed patients of cutaneous tuberculosis attending dermatology out patient department over a period of 1 year were included in the study. A detailed clinical examination and investigations including histopathological examination were carried out. Results: Scrofuloderma was the most common form seen in 50% cases followed by lupus vulgaris in 42.86%, tuberculosis verrucosa cutis in 4.76%, and lichen scrofulosorum in 2.38% cases. The Mantoux test was positive in 83.33% cases. Characteristic tuberculoid granulomas were seen in 72.22% cases of lupus vulgaris, 42.86% cases of scrofuloderma and all cases of tuberculosis verrucosa cutis and lichen scrofulosorum. Conclusion: Cutaneous tuberculosis is still highly prevalent in upper Assam. Early diagnosis and treatment are essential to prevent its complications