Talaromycosis in Assam: a case report

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

Clinicopathological study of puerperal sepsis including microbiological profile: at a tertiary health care centre

Background: Puerperal sepsis in developing countries is a major health problem. Antenatal and labour related risk factors play a huge role in causing puerperal sepsis, many of which are modifiable. The aim of the present study is to study the risk factors, clinical features and outcomes of puerperal sepsis in the mother and determine the causative microorganisms involved.Methods: A prospective observational study was conducted at the department of Obstetrics and Gynaecology, Assam Medical college and Hospital from 1st July 2016 to 30th June 2017.Peurperal sepsis cases were identified based on the WHO clinical definition. A total of 88 patients were identified. Information regarding occupation, antenatal care, delivery related events and outcome were recorded on a predesigned proforma. Mothers were followed up till discharge from the hospital.Results: Out of 88 clinically diagnosed patients with puerperal sepsis, common risk factors associated with mortality were young age(p<0.001),primiparity(p 0.005),tea garden workers(p 0.014),few antenatal check-ups and unbooked status (p 0.001) inadequate iron prophylaxis .Among labor related events intrauterine fetal demise (p 0.001), absent membranes on admission (0.001),late presentation (p 0.001) delivery by untrained birth attendant (p <0.001) were significant.24 patients expired due to the disease. Most common isolated in high vaginal swab and blood culture were Klebsiella pneumoniae and CONS respectively.Conclusions: Proper antenatal care and institutional deliveries are the prime and only preventive measure to reduce the burden of puerperal sepsis in our setup

Seroprevalence and risk factors of herpes simplex virus type-2 infection among pregnant women in Northeast India

<p>Abstract</p> <p>Background</p> <p>Herpes simplex virus type-2 (HSV-2) is one of the most common sexually transmitted infections that facilitate human immunodeficiency virus (HIV) acquisition by over two fold or more. The development of HSV-2 control methods as a measure to control HIV epidemic in high HSV-2/HIV areas has become a priority. Two out of the six high HIV prevalent states of India are located in the Northeastern region of India. Due to lack of documented HSV-2 studies from this part of the country; there was a need for estimating the seroprevalence and risk factors of HSV-2 infection in this defined population.</p> <p>Methods</p> <p>Pregnant women (n = 1640) aged18 years and above attending antenatal clinics of tertiary referral hospitals in five Northeastern states of India were screened for type specific HSV-2 IgG antibodies. Blood samples were collected from all the participants after conducting interviews. Univariate and multivariate analyses were performed to identify the risk factors associated with HSV-2 seropositivity.</p> <p>Results</p> <p>Overall seroprevalence of HSV-2 infection was 8.7% (142/1640; 95% CI 7.3-10.0) with a highest prevalence of 15.0% (46/307; 95% CI 11.0-19.0) in the state of Arunachal Pradesh. Higher seroprevalence was observed with increasing age (Adj. Odds Ratio [AOR] 1.9 for 22-25 years old, AOR 2.29 for > 29 years old). The risk factors associated with HSV-2 seropositives were multiple sex partners (AOR 2.5, <it>p </it>= 0.04), condom non-user's (AOR 4.7, p <it><</it>0.001), early coitarchal age (age of first intercourse) 'less than 18 years' (AOR 9.6, <it>p = </it>0.04), middle income group (AOR 2.1, <it>p = </it>0.001) compared to low income group and low level of education (AOR 3.7, <it>p = </it>0.02) compared to higher education. HSV-2 seropositivity was higher among Christians (12.6%) compared to Muslims (3.8%). The most frequent clinical symptoms among HSV-2 seropositives were excess vaginal discharge in last one year (53.5%, 76/142) and pelvic pain (26.1%, 37/142). While among subjects with genital ulcers, HSV-2 seroprevalence was 36.8% (7/19).</p> <p>Conclusions</p> <p>Overall seroprevalence of HSV-2 infection among pregnant women of Northeast India is relatively low. The generation of awareness among high risk groups may have played key role to limit the infection. The role of vaccination against HSV-2 in near future and elimination of HSV-2 viral shedding along with genital tract inflammation in high HIV/HSV-2 areas may be an option for initiating successful intervention strategies to reduce the transmission and acquisition of HIV infection in Northeast India.</p

Drug resistant Shigella flexneri in & around Dibrugarh, north-east India

Background & objectives: Shigella flexneri is the most common species of Shigella causing diarrhoea and dysentery in Asia including India. Multidrug resistance in Shigella species has been reported worldwide and there is rising concern regarding development of fluoroquinolone resistance. This study was undertaken to find out the resistance pattern of Sh. flexneri, the commonest shigella isolated in Dibrugarh, north east India, including detection of fluoroquinolone resistance and extended spectrum beta lactamases. Methods: Stool samples collected from patients of diarrhoea and dysentery were tested for bacterial enteropathogens. Strains of Shigella species were confirmed by biochemical tests. Speciation was done using commercially available polyvalent antiserum. Antimicrobial susceptibility test was performed by Kirby Bauer disc diffusion method against 18 different antibiotics. Extended spectrum beta lactamase (ESBL) detection was done by disc approximation test as well as combination disc method and minimum inhibitory concentrations (MIC) of different antibiotics were also measured. Results: Multidrug resistance in Sh. flexneri was found to be common (90.2%) and the commonest phenotypic multi-drug resistance profile was ampicillin-tetracycline-co-trimoxazole-nalidixic acid. High resistance to nalidixic acid was detected in 90.3 per cent isolates (MIC >240 μg/ml) and ciprofloxacin resistance was seen emerging in this region (11.2%, MIC >4 μg/ml). Present of ESBL was phenotypically confirmed in two cases. Besides the fluoroquinolones, chloramphenicol, piperacillin-tazobactum and the third generation cephalosporins were effective in 87-100 per cent of the isolates. Interpretation & conclusions: Our study showed high resistance (MIC >240 μg/ml) against nalidixic acid in Sh. flexneri isolates. Ciprofloxacin resistance is also emerging in this region. Shigellosis due to ESBL carrying Shigella can become a serious threat to public health. Guidelines for therapy should be monitored and modified based on regional reports of resistance to antimicrobial agents

Dermatitis due to straw itch mite in Assam

Mites belonging to Pyemotidae family are an important cause of human dermatoses. Though their bites are painless, yet, afterwards severe itching and possible secondary infection. Most of the time mites could not be demonstrated from the lesion. We are presenting a case where mites could be seen in scrapping from a typical lesion in man

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