Biomedical subjects
Publications and source records attributed to H C Gugnani.
Human infections due to Cladosporium oxysporum are rarely known. This case report describes cutaneous phaeohyphomycosis cause by C. oxysporum in a 30-year-old female. Lesions presented as multiple coalescing ulcers on the left foot. Diagnosis was based on histology and recovery of the fungus in culture. The patient was successfully treated with potassium iodide.
The association of Cryptococcus gattii with Eucalyptus trees has been well established. Here we report the isolation of both C. gattii and Cryptococcus neoformans var. grubii from the flowers and bark of Eucalyptus trees in India. We investigated a total of 233 samples of Eucalyptus trees: 120 flowers, 81 fragments of bark, and 32 leaves. C. gattii was isolated from two samples of flowers of Eucalyptus terreticornis. C. neoformans var. grubii was recovered twice from the bark of Eucalyptus camaldulensis, initially from one of three samples, and again 2 months later, from one of four samples collected beneath the canopy of the tree. The primary isolation medium was Nigerseed agar, and brown colonies were presumptively identified as C. gattii or C. neoformans. The species identification was confirmed by morphological and biochemical characteristics. Using the Crypto-Check kit (Iatron, Tokyo, Japan), the first two isolates were identified as serotype B (C. gattii) and the other two were serotype A (C. neoformans var. grubii). PCR analysis of the isolates of C. neoformans var. grubii revealed that they possessed the MATalpha mating type allele. Molecular typing by amplified fragment length polymorphism markers indicated that both isolates of C. neoformans var. grubii possessed the same genotype. This study demonstrates that C. neoformans var. grubii, as well as C. gattii, may be associated with Eucalyptus trees.
Aspergillus fumigatus and related species are widely distributed in nature. The majority of the species belonging to this genus are saprophytic in nature. Only a few species including A. fumigatus are capable of causing diseases in man. These opportunistic agents may cause infection or allergy in susceptible individuals. These fungi also cause diseases in animals, birds, and in plants. In addition, some of the enzymes and metabolic products have tremendous value in industry. A few of the Aspergillus species produce potent toxins of the aflatoxin family, which can cause cancer. Toxic death due to aflatoxins has been reported in humans, animals, and birds. There are currently about 180 recognized species of Aspergillus, and these species are placed in 6 subgenera, which are further divided into several sections. The telemorphs belonging to the genera are Chaetosartorya, Dichlanea, Eurotium, Emericella, Fennellia, Hemicarpentales, Neosartorya, Petromyces, Sclercleisia, and Warcupiella. This review presents a concise overview of the ecology, taxonomy, and genetics of Aspergillus species including their role in plant, animal, and human diseases, production of toxic metabolites, and molecular methods for their identification.
An outbreak of candidemia due to Candida tropicalis involving 16 neonates (gestational age 28-36 weeks) is reported. All infants had received hyperalimentation and at least one course of antibiotics. The commonest clinical manifestations included episodes of acute respiratory distress and lack of response to antibacterial antibiotic therapy. Candida tropicalis was recovered from blood in all the 16 infants and urine cultures were positive in 14 infants. Environmental sampling yielded C. tropicalis from one each of the blankets and mattresses used for neonates. Four of five urinary tract isolates and both environmental isolates genotyped by arbitrarily primed-PCR with several random primers were shown to belong to the same genotype.
The present investigation represents the first study of oropharyngeal carriage of Candida and other yeasts in HIV-infected patients in India. One hundred and fifty HIV-positive patients were investigated by culturing their swish samples on plates of CHROMagar Candida. Ninety-eight patients (65.3%) were positive for Candida and four (2.7%) were positive for other yeasts. Among them, the first Indian C. dubliniensis isolate has been recovered. Molecular typing of selected C. albicans isolates by AP-PCR revealed two major genotypes based on the banding patterns. The susceptibilities of 30 Candida isolates to five antifungal agents including the new triazole voriconazole were determined in a micro-dilution test, according to the NCCLS protocol M 27. All the 22 C. albicans isolates were susceptible to five antimycotic agents (flucytosine, amphotericin B, fluconazole, voriconazole and itraconazole) except one isolate (VPCI-122), which was resistant to flucytosine (MIC > or = 64 mg l-1). The azole-resistant isolates reported here endorse the role of antifungal susceptibility testing whenever antifungal treatment with azoles is planned.
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Seventy-two mycologically proven cases of otomycosis (38 males, 34 females) aged 8-80 years were investigated. Aspergillus niger was the commonest aetiological agent (43.1%) followed by Candida spp. (22.2%), A. flavus (19.4%) and A. fumigatus (15.3%). Three topical drugs, namely mercurochrome, clotrimazole and locacorten-vioform, were evaluated for otomycosis therapy in separate groups of 24 patients each. Mercurochrome was found to be the most efficacious in terms of healing, relief from symptoms of the disease and production of negative fungal cultures. Mercurochrome is recommended as a safe and economical drug for the topical treatment of otomycosis in developing countries like Nigeria.
High vaginal swabs (HVS) obtained from 500 volunteers in Edo State, Nigeria which comprised 394 contraceptive users and 106 non-contraceptive users were screened for the prevalence of Candida species using standard procedures. Results revealed the isolation of Candida species in 246 of volunteers. These included Candida albicans 174 (38.4%), Candida pseudotropicalis 20 (4%), Candida stellatoidea 15 (3%), Candida krusei nine (1.8%), Candida guilliermondii 12 (2.4%), Candida tropicalis 11 (2.2%) and Candida glabrata five (1%). Of the 394 contraceptive users, 203 (51.5%) had Candida species isolated from them compared to 43 (40.6%) from 106 non-contraceptive users. There was significant relationship (P<0.001) between the type of contraceptive used and the prevalence of vaginal colonization. Age and marital status of the volunteers sampled had significant relationship (P<0.001) with the prevalence of vaginal colonization. Results have revealed an association between use of contraceptive and the prevalence of vaginal colonization in our environment.
A case of meningitis in a 38-year old male with pulmonary tuberculosis is described. Cryptococcus neoformans was isolated from the cerebrospinal fluid. The isolate belonged to variety neoformans serotype AD. The patient died before any antimycotic therapy could be instituted.
A case of subcutaneous phaeohyphoymycosis caused by Cladosporium cladosporioides in a 25-year-old male is described. The clinical presentation was an elevated scaly suppurating lesion with sinuses on the right leg. The lesion healed completely with oral fluconazole therapy. The present report constitutes the first record of cutaneous or subcutaneous infection due to Cl. cladosporioides from India.
Serum samples from 60 subjects with confirmed HIV-1 infection including 28 AIDS patients and 32 carriers were examined by immunodiffusion for precipitating antibodies to antigens of Histoplasma, Blastomyces and Candida. Seven of the subjects, four patients and three carriers, showed antibodies to histoplasmin prepared from mycelial cultural filtrate of Histoplasma capsulatum var. capsulatum and H. capsulatum var. duboisii although without any clinical signs of classical or African histoplasmosis. Another eight subjects comprising five patients and three carriers demonstrated antibodies to yeast cell antigen of Candida albicans; three of the patients had oral lesions clinically suggestive of Candida infection. None of the serum samples revealed antibodies to "A" antigen (yeast cell antigen) of Blastomyces dermatitidis.
Although there has over recent years been a marked rise in the incidence of serious fungal infections, many of which are prevalent in developing countries, few facilities exist for diagnosis and research in medical mycology. In most countries, medical mycology is not taught adequately to medical students and consequently there is little awareness of the importance of fungal infections. Model teaching programmes need to be developed. Practical knowledge of mycoses, their diagnosis and treatment and also basic mycology can be disseminated through well-constructed courses and workshops. Formalized training in mycology research also needs to be introduced. To achieve all of this, expertise and additional resources need to be made available. In this regard, ISHAM can and should help.
Zygomycosis due to Basidiobolus ranarum (entomophthoromycosis basidiobolae, subcutaneous zygomycosis, subcutaneous phycomycosis, basidiobolomycosis) is a granulomatous infection of the skin and subcutaneous tissues characterized by the formation of fluctuant firm and non-tender swellings, generally on the extremities, trunk and rarely other parts of the body. The causative agent is common in soil, decaying vegetable matter, and the gastrointestinal tracts of amphibians, reptiles, fish and bats. It is presumed that infection is acquired through exposure to B. ranarum following minor trauma to skin or insect bites. The disease usually occurs in children, less often in adolescents and rarely in adults. Males are much more frequently affected than females. Laboratory diagnosis is based on histopathology and culture. The typical histopathological feature is the presence of thin-walled, broad often aseptate hyphae or hyphal fragments with an eosinophilic sheath, frequently phagocytized within giant cells. Basidiobolus ranarum is known to produce several enzymes, e.g. lipase and protease that probably play roles in the pathogenesis of infections caused by this mould. An immunological test has been developed for specific diagnosis of the disease. Though potassium iodide (KI) has been the traditional drug employed in the treatment of infections by B. ranarum, several other drugs, viz amphotericin B, cotrimoxazole, ketoconazole, itraconazole and fluconazole have been successfully tried.
Emerging pathogens are those infective organisms whose incidence has recently increased or is likely to increase during the next two decades due to changes in demography, food habits, food technology, commerce, water sources and environmental factors. Some important emerging food and water borne bacterial pathogens include Listeria monocytogenes, Campylobacter jejuni, Yersinia enterocolitica, Salmonella enteritidis, Escherichia coli O157: H7, Vibrio cholerae biotype E1 Tor Serotype 0139, Vibrio parahaemolyticus and Aeromonas hydrophila, A. sobria, and A. caviae. The prevalence, ecological relationships of these organisms, their transmission through food, water and other environmental sources, and role of their virulent factors in the pathogenesis of infections and their public health significance is discussed in this paper with special reference to the situation in India.
Two patients with African histoplasmosis manifested by ulcers and cutaneous swellings are described. The inguinal lymph nodes were also involved in one patient. Treatment with amphotericin B combined with ketoconazole was successful.
A fatal case of cerebral phaeohyphomycosis in a 45-year-old Nigerian woman is described. The main clinical features were loss of vision, constant severe headache and the presence of a tumorous mass in the brain as detected on operation. Histology revealed granulomatous tissue reaction with fungal elements suggestive of Xylohypha bantiana.
A 1% cream of sulconazole nitrate, an imidazole derivative, was used to treat 38 patients with diverse clinical types of dermatomycoses, including 16 cases of pityriasis versicolor, 14 of dermatophytosis (tinea pedis, tinea cruris, tinea corporis), two of balanoposthitis due to Candida albicans, another two of candidosis of the groin, one each of groin and foot infection due to Trichosporon beigelii and one case each of lesions of the hand and trunk caused by Petriellidium boydii and Scytalidium hyalinum respectively. A complete cure was achieved in 91% of patients, with resolution of the lesions in the majority within 2-4 weeks. There were only two relapses. Sulconazole is recommended as an effective drug for topical treatment of superficial fungal infections of the skin.