Biomedical subjects
Publications and source records attributed to S Verghese.
Scedosporium apiospermum, the asexual state of Pseudallescheria boydii, is increasingly recognized as an opportunistic pathogen. We report a case of prosthetic valve endocarditis caused by this organism that developed in a patient following cardiac surgery.
Fungal valvular endocarditis is an unusual cause of endocarditis, yet very important because of its historically poor prognosis. We report two fatal cases of fungal valvular endocarditis following cardiovascular surgery, presenting as femoral artery embolism. Aspergillus terreus and A. flavus were the causative agents of endocarditis in the two patients. Diagnosis was established very early by culture of the emboli and was confirmed later by isolation of the same Aspergillus species from the resected valve tissue.
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We describe a fatal case of imported coccidioidomycosis in India in a 22-year-old male who worked in Tucson, Arizona, approximately four years prior to his illness. The diagnosis was based on the presence of characteristic spherules with endospores in biopsy tissue of lymph nodes, bone and pus from a chronic discharging sinus in the left gluteal region and isolation of Coccidioides immitis in culture. C. immitis is one of the most infectious and virulent fungal pathogens and poses a serious occupational hazard for laboratory personnel, especially in areas where the disease is not endemic. To reduce the role of laboratory-acquired infection, all procedures that involve manipulation of cultures of C. immitis should, whenever possible, be conducted in a biological safety cabinet.
A case of invasive pulmonary aspergillosis in a 33-year-old, non-immunocompromised male presenting with lower limb paraplegia is reported. The clinical manifestations, diagnosis, and combined medical and surgical management of this rare condition are described.
A case of Aspergillus terreus causing sclerosing mediastinitis which presented with symptoms of cardiorespiratory compromise and compressive myelopathy is described. The diagnosis was established by culturing and isolating the fungus in pure culture from the tissue and was also confirmed by demonstration of sepcific precipitating antibodies against Aspergillus terreus in patient's serum.
A total of 326 high vaginal swabs from infertile women attending the Institute of Reproductive Medicine were cultured from June 1999 to May 2000. Candida species was isolated from 42(12.88%) patients. Candida albicans (40.47%) followed by Candida glabrata (38.09%) were the most common isolates. Other species included Candida tropicalis (14.28%) and Candida krusei (7.14%). All isolates were tested for sensitivity by disc diffusion method on Yeast Nitrogen Agar base towards four antifungals. Seven (16.7%) candida strains showed resistance to Fluconazole and 19(45.23%) of the strains showed resistance to Itraconazole, and 4(9.5%) strains showed resistance to Nystatin. There was no resistance to Amphotericin B. Of the 7 strains resistant to Fluconazole, 3 were Candida krusei, 3 were Candida glabrata and 1 was Candida tropicalis.
From May, 1999 to April, 2000, 256 high vaginal swabs were culture from asymptomatic infertile women attending the out-patient department of the Institute of Reproductive Medicine. 41 strains of Streptococcus agalactiae were isolated from 33 patients (12.89%). Five patients had repeated isolations even after adequate therapy.
Somatic chromosomal mosaicism may present as isolated pigmentary abnormalities or multiple congenital anomalies with mental retardation. Pigmentary lesions are visually dramatic and are differentiated based on appearance when the underlying pathogenesis is not known. It is now clear that mosaicism is responsible for the pigmentary findings in hypomelanosis of Ito (HI) and linear and whorled nevoid hypermelanosis (LWH). Both hypopigmentation and hyperpigmentation have been noted in the same individual, and both LWH and HI can be caused by similar chromosomal abnormalities. Both of these conditions exhibit similar systemic involvement. We present a case of LWH associated with mosaic trisomy 7 and review the relevant literature.
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Infusion therapy carries a substantial risk of producing iatrogenic sepsis, bacteremia or fungemia originating from the device used for vascular access or from the contaminated infusate. This study, a semiquantitative assay of the central venous catheter tips (CVC) was carried out and correlated with the blood culture results to determine the probable cause of sepsis in our post operated patients. One thousand six hundred and thirty one surgeries were performed in the Institute of Cardio-Vascular Diseases from January to December 1997. We received 150 CVC tips which were in place for more than five days for culture. Fifty one (51) CVC tips showed growth in either contents or roll. There was associated blood stream infection in 23 patients. The age groups of patients ranged from two months to 67 years and male to female ratio was 109:41. Children below the age of 12 years were 62 in number. Candida spp. (32.4%) and Staphylococcus spp. (33.9%) formed the predominant isolates from the CVC tips.
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Ecological niches of Staphylococcus aureus are the anterior nares. Carriage of Staphylococcus aureus in the nose appears to play a key role in the epidemiology and pathogenesis of infection. Numerous studier have shown that elimination of nasal carriage using Mupirocin also eliminated hand carriage and the spread of infections in hospitals. Lipovitellin-Salt-Mannitol Agar was used for screening, isolation and presumptive identification of Staphylococcus aureus from nasal carriers. From November; 97 to August'98, 724 nasal swabs were cultured and 18.23% of health care workers were found to be nasal carriers of Staphylococcus aureus. Of these 12.15% were carriers of MRSA. The carrier rate was highest in December' 97 (32.07%). All MRSA carriers were treated with local application of Mupirocin for three days. A study of the antibiogram of the clinical isolates during the corresponding period showed 100% susceptibility of MRSA to Vancomycin. Susceptibility of MRSA to Clindamycin, Netilmycin, Rifampicin & Ofloxacin was 86.6%, 69.5%, 66% & 64.7% respectively.
Brucela serology using ELISA and standard agglutination test was performed on 23 patients with prolonged fever where the test was requested, on 26 randomly chosen patients with prolonged fever where it was not requested and on 17 controls. ELISA was positive in 39.1, 26.9 and 0 per cent respectively in these groups. Brucellosis may often be unsuspected because of its varied clinical manifestations and may be a more important cause of fever than previously considered. Our data reaffirm that ELISA is superior to the standard agglutination test for the diagnosis of brucellosis.
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The epidermis was stained with a panel of recently produced anti-guinea pig leucocyte antibodies. Guinea pig Langerhans cells were not detectable with antibodies directed against B lymphocytes (MSgp9), T lymphocytes (CT7 and MSgp7), T-helper/inducer (MSgp12) and putative T-suppressor/cytotoxic (CT6 and MSgp6) subsets. Langerhans cell expressed both major histocompatibility complex (MHC) class-I and II antigens and also an epitope (CT4) associated with lymphocyte migration, thus suggesting the migratory potential of this cell. Although the Langerhans cell did not express macrophage specific antigens, MSgp5, which detects lymphoid dendritic cells, was weakly expressed on the Langerhans cell. The Langerhans cell expressed a leucocyte-common antigen detected by H201. Double-labelling studies with anti-MHC class-II antibodies indicated that only 0.4 +/- 0.3% of the pan leucocyte-positive epidermal cells were Ia-negative, indicating that it is unlikely that a guinea pig analogue of the murine Thy-1 + dendritic epidermal cell (Thy-1 + dEC) exists.
Dendritic cells were enriched from guinea pig auricular lymph nodes containing Mycobacterium leprae induced granulomas by immunomagnetic depletion of other cells. These cells were strongly positive for major histocompatibility complex class II antigens and labelled with an antidendritic cell monoclonal antibody, but not with an antimacrophage antibody. Interdigitating dendritic cells were identified in the granulomatous lymph node by staining with the antidendritic cell antibody and by transmission electron microscopy. When cultured in vitro with purified T lymphocytes, these cells acted as accessory cells for both purified protein derivative and concanavalin A induced proliferation. Although previous studies have shown that macrophages from these lymph nodes do not act as accessory cells, the present results indicate that dendritic cells from M. leprae granuloma containing lymph nodes may act as antigen-presenting cells.
A possible model for nerve damage in leprosy has been developed in the sciatic nerve of the guinea pig. Intraneural injection of 10(7) BCG organisms into an unsensitized animal induces an epithelioid cell granuloma in 2 weeks similar to that found in tuberculoid leprosy patients. In contrast, intraneural injection of 10(9) cobalt-irradiated Mycobacterium leprae organisms induces a macrophage granuloma in 5 weeks, similar to that found in lepromatous leprosy patients. Histological, immunohistochemical, electron microscopical and electrophysiological studies have demonstrated that the lesions induced in the experimental animals show many of the features documented in studies of nerve damage in leprosy patients.