Fungal thalamic abscess caused by Rhinocladiella mackenziei in an immunocompetent patient.

Cerebral phaeohyphomycosis (CP) stands as an exceedingly uncommon yet severe type of fungal infection affecting the central nervous system, attributable to dematiaceous fungi. Despite the patient's immune status, CP is associated with grave prognosis. In the present study, authors describe the first case of left thalamic fungal abscess due to Rhinocladiella mackenziei in an immunocompetent 39-year-old male patient in Jaipur, Rajasthan. Early diagnosis by direct microscopy of aspirated pus and extensive management with surgical excision and prolonged antifungal coverage showed favourable outcome. The present case is one of the few cases documented globally who has survived.

Vaginal pH Estimation, an Additional Tool for RTI/STI Community Screening.

Objective: To study laboratory evidence of infection in STI/RTI cases managed by syndromic approach. To evaluate vaginal pH estimation as an additional supplementary tool for community screening of STI/ RTI cases. Material and Methods: Study was conducted in department of Gynecology and Obstetrics, Mahila Chikiksalaya Sanganeri gate Jaipur in collaboration with Department of Microbiology, SMS Medical College Jaipur, Rajasthan. STI cases screened by syndromic approach attending the STI clinic were included in study. Vaginal pH of these cases was measured with help of Jaipur pink V strip. Cases with vaginal pH more than five and less than 5 were grouped separately. Evidence of infection was assessed in both groups by performing predefined battery of tests. Results of both the groups were analyzed. Results: Laboratory evidence of infection was seen in 78% of syndromically screened RTIs/STI cases while screening by combined approach, i.e., syndromic approach and Vaginal pH estimation both, showed positive predictability of 92% with 75% sensitivity and 79% specificity. Conclusion: Laboratory evidence of infection was found in 92% of RTI/STI cases when screened by combined approach as compared to 78% in syndromic approach alone. Vaginal strips being user friendly can be used as additional tool for community screening of RTI/STI.

Diagnostic accuracy of saliva as a specimen for detection of SARS-CoV-2 by RT-PCR.

Context: COVID-19 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an emerging pandemic that is rapidly spreading with more than 114 million confirmed cases and 2.5 million deaths by far. Nasopharyngeal swab (NPS) in VTM has been used as the gold standard respiratory specimen for SARS-CoV-2 reverse-transcriptase real-time PCR (rRT-PCR) tests. But now the virus can also be detected in other clinical specimens like bronchoalveolar lavage, sputum, saliva, throat swab, blood, and stool specimens. Aims: The aim of this study was to determine the diagnostic potential of saliva as a sample in comparison to NPS for detection of SARS-CoV-2 by rRT-PCR. Settings and Design: A cross-sectional study was conducted among 256 paired samples (NPS and Saliva) received in the Department of Microbiology, SMS Medical College, Jaipur over a period of 2 months. Methods and Material: NPS from individuals were collected in a sterile tube containing Viral Transport Medium™. Before swab collection, whole saliva was collected by spitting from the suspected patient into a sterile container. Both were stored at room temperature and transferred to the diagnostic laboratory within four hours of collection where extraction was done using Perkin Elmer chemagic extractor and rRT- PCR was performed using NIV, Pune mastermix. Results: Sensitivity, specificity, PPV, and NPV of RT-PCR for the diagnosis of COVID-19 in saliva were 84.26%, 100%, 100%, and 54.05%, respectively. The accuracy of detection of COVID-19 by saliva samples compared to the routinely used NPS samples (considered as the standard reference) for RT PCR was 86.72%. Conclusions: Our results show that saliva as a reliable sample type for SARS-CoV-2 detection.

Evaluating the presence of SARS-CoV-2 in the intraocular fluid of COVID-19 patients.

PURPOSE: To detect the presence of SARS-CoV-2 in aqueous and vitreous humor of COVID-19 patients in a pilot study. METHODS: : Consecutive patients planned for emergency ophthalmic surgeries after ocular trauma were subjected to naso-oropharyngeal RT-PCR test for SARS-CoV-2. Laboratory-confirmed cases were enrolled for the study. During surgery, 0.1 mL aqueous and vitreous each was aspirated. The vitreous tap was collected on clinical suspicion of endophthalmitis. RT-PCR test was used to detect SARS-COV-2 nucleotide in the samples. Cycle threshold (Ct) for E gene of ≤35 along with confirmatory results on one of the two target genes (RdRp or ORF1b) was considered as positive. RESULTS: : One hundred and thirty two patients were found positive on naso-oropharyngeal RT-PCR test for SARS-CoV-2 preoperatively. Seven patients with ocular trauma were studied. The mean age was 31.8 years. There were six male and one female patient. Two patients had symptoms of mild COVID-19 disease and the rest were asymptomatic. The mean Ct value of the E gene on naso-oropharyngeal RT-PCR was 23.14 ± 4.7. Corneal and corneoscleral laceration repair was done in five patients, intracorneal wooden foreign body was removed in one patient, and injection of intravitreal antibiotics was done in one patient. Aqueous and vitreous tap was collected in 7 and 5 patients, respectively. None of the aqueous or vitreous samples was found positive for SARS-CoV-2. CONCLUSION: : SARS-CoV-2 was not detected by RT-PCR in aqueous or vitreous humor in this pilot study. Future studies with a larger sample size are needed to further explore the presence of SARS-CoV-2 in intraocular fluids.

Phenotypic Detection of Carbapenemase Production in Carbapenem-Resistant Enterobacteriaceae by Modified Hodge Test and Modified Strip Carba NP Test.

Objective Carbapenems are last resort antibiotics for multidrug-resistant Enterobacteriaceae . However, resistance to carbapenem is increasing at an alarming rate worldwide leading to major therapeutic failures and increased mortality rate. Early and effective detection of carbapenemase producing carbapenem-resistant Enterobacteriaceae (CRE) is therefore key to control dissemination of carbapenem resistance in nosocomial as well as community-acquired infection. The aim of present study was to evaluate efficacy of Modified strip Carba NP (CNP) test against Modified Hodge test (MHT) for early detection of carbapenemase producing Enterobacteriaceae (CPE). Material and Methods Enterobacteriaceae isolated from various clinical samples were screened for carbapenem resistance. A total of 107 CRE were subjected to MHT and Modified strip CNP test for the detection of CPE. Statistical Analysis It was done on Statistical Package for the Social Sciences (SPSS) software, IBM India; version V26. Nonparametric test chi-square and Z -test were used to analyze the results within a 95% level of confidence. Results Out of 107 CRE, 94 (88%) were phenotypically confirmed as carbapenemase producer by Modified strip CNP test and 46 (43%) were confirmed by Modified Hodge Test (MHT). Thirty-eight (36%) isolates showed carbapenemase production by both MHT and CNP test, 56 isolates (52%) were CNP test positive but MHT negative, eight (7%) isolates were MHT positive but CNP test negative and five (5%) isolates were both MHT and CNP test negative. There is statistically significant difference in efficiency of Modified CNP test and MHT ( p < 0.05). Conclusion Modified strip CNP test is simple and inexpensive test which is easy to perform and interpret and gives rapid results in less than 5 minutes. It has high degree of sensitivity and specificity. Modified strip CNP test shows significantly higher detection capacity for carbapenemase producers as compared with MHT.

Mycological Profile of Sputum of HIV Positive Patients with Lower Respiratory Tract Infection and its Correlation with CD4+ T Lymphocyte Count.

INTRODUCTION: Fungal respiratory infections are important cause of mortality and morbidity among HIV positive individuals. They account for up to 70% of illness in Acquired Immunodeficiency Disease Syndrome cases (AIDS). The range of illness varies from asymptomatic mucosal candidiasis to overwhelming disseminated infections. In these patients dissemination of fungus leads to very serious outcomes hence, it is important to have the knowledge of prevailing profile of fungus causing infections, so that it can be treated at the onset. Low CD4+ T lymphocyte count is an excellent indicator of decreased immunity and can also be helpful to predict opportunistic fungal respiratory infections and other complications. AIM: To define the fungal aetiology of lower respiratory tract infections in HIV positive patients and to correlate the occurrence of different fungi with CD4+ T lymphocyte count. MATERIALS AND METHODS: This was a cross sectional study conducted between May 2014 to April 2015, on 180 treatment naive HIV seropositive patients with lower respiratory tract infections attending the Integrated Counselling and Testing Centre, SMS Medical College, Jaipur, Rajasthan. Early morning expectorated and induced sputum samples were collected and processed for isolation and identification of fungal species. CD4+ T lymphocyte count estimation was done by BD FACS Calibur. RESULTS: Fungal species were isolated from 155 (86.1%) patients. The most common isolate was Candida albicans (31.7%), followed by Aspergillus niger (17.7%) and Aspergillus flavus (10%). The fungal species were most commonly isolated from patients with CD4+ T lymphocyte cell less than 200 cells/µl. CONCLUSION: Fungal infections were seen in 86.1% of HIV positive patients with lower respiratory tract infections hence, high level of clinical suspicion for fungal aetiology of respiratory infections in HIV positive patients should be kept in mind.

Hepatitis B virus seroprevalence and its correlation with CD4 cells and liver enzymes among human immunodeficiency virus positive individuals at a tertiary care hospital in North-West India.

BACKGROUND: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are global health concerns. Due to shared routes of transmission, co-infection is common. Their co-existence can cause severe liver complications and immunological impairment in infected individuals. AIM: To find the prevalence of HBV co-infection in HIV patients and to assess the pattern of liver enzymes and CD4 T-cell counts in HIV monoinfected and HIV/HBV co-infected patients. MATERIALS AND METHODS: A total of 342 consecutive confirmed HIV positive treatment naïve patients were tested for hepatitis B surface antigen (HBsAg). Clinical staging was done according to Centers for Disease Control and Prevention classification guidelines. Liver function tests were performed by an autoanalyser. CD4 T-cells were estimated by FACS Calibur. RESULTS: Hepatitis B virus co-infection was detected in 8.7% of HIV positive patients as compared to 1.42% in the HIV negative control group (P < 0.05). Majority of the HIV monoinfected and co-infected patients were below 38 years. HBsAg positivity was higher in males (9.4%) and the route of transmission was heterosexual. Categorical data revealed significantly higher proportion of alanine aminotransferase and aspartate aminotransferase (AST) in the co-infected patients compared to the monoinfected patients (P < 0.05). The HIV/HBV co-infected patients had significantly lower CD4 T-cell counts (P = 0.03) and significantly higher AST, alkaline phosphatase and serum bilirubin values (P = 0.023, P = 0.029, P = 0.009 respectively) than the monoinfected group. Males had 1.33 times higher risk than females for co-infection (odds ratio = 1.33; 95% confidence interval 0.57-3.10). CONCLUSION: The prevalence of co-infection was high. Raised levels of liver enzymes and lowered CD4 counts were seen in co-infected patients. These findings underscore the importance of HBV screening of all HIV positive individuals before initiating antiretroviral treatment.

First reported cases of diffuse cutaneous leishmaniasis in human immunodeficiency virus positive patients in Jaipur District of Rajasthan, India.

Diffuse cutaneous leishmaniasis (DCL) is characterized by the presence of a large number of lesions at several anatomic sites (head, limbs and trunk). The lesions include papules, nodules and areas of diffuse infiltration that do not ulcerate and reveal abundant parasites on histopathological examination. DCL and human immunodeficiency virus (HIV) co-infections are seldom reported. We report two cases of DCL in HIV positive patients without visceral involvement. DCL is emerging as a new opportunistic infection associated with HIV/acquired immunodeficiency syndrome.

The Prevalence of Intestinal Parasitic Infestation and the Related Profile of the CD4 (+) Counts in HIV/AIDS People with Diarrhoea in Jaipur City.

INTRODUCTION: Gastrointestinal Tract (GIT) infections are among the most frequent infections in HIV/AIDS patients. The intestinal opportunistic parasitic infections in HIV-infected subjects present most commonly as diarrhoea. A study was conducted to determine the prevalence of enteric parasitic infections in HIV infected patients with diarrhoea, with different levels of immunity. METHODS: This study was carried out at the HIV Lab of the Microbiology Department of a tertiary care teaching hospital in Jaipur, Rajasthan, between June-October 2009 among consecutively enrolled 75 HIV infected patients who presented with diarrhoea. Stool samples were collected and examined for enteric parasites by using microscopy and special staining methods. The CD4 (+) cell counts were estimated by using the FACS count system. RESULTS: Intestinal parasitic pathogens were detected in 38.66% patients, Cryptosporidium species was the most common enteric opportunistic parasite which accounted for 37.93 % of the total parasites, followed by Isospora belli 31.03 %. In the HIV infected patients with CD4 (+) counts of < 200 cells/µl, parasites were identified in 56.25 % patients and in HIV patients with CD4 (+) counts between 200-499 cells /µl, parasites could be identified in 27.5 % of the patients . No parasite was detected in the patients with CD4 (+) counts of >500 cells/ µl. CONCLUSION: Parasitic infections were detected in 38.66% HIV infected patients with diarrhoea and a low CD4 (+) count was significantly associated with opportunistic infections. Identification of the aetiological agent of diarrhoea in an HIV patient is very important, as it can help in the institution of the appropriate therapy and the reduction of the morbidity and the mortality in these patients.

Enteric pathogens in HIV-positive patients with diarrhoea and their correlation with CD4+ T-lymphocyte counts.

BACKGROUND AND OBJECTIVES: Opportunistic parasitic infections are among the most serious infections in human immunodeficiency virus (HIV) positive patients and claim number of lives every year. The present study was conducted to determine the prevalence of intestinal parasites and to elucidate the association between intestinal opportunistic parasitic infection and CD4 (CD4+ T lymphocyte) counts in HIV-positive patients. MATERIALS AND METHODS: The study was done on 266 HIV-positive patients presenting with diarrhoea and 100 HIV-positive patients without diarrhoea attending the integrated counselling and testing centre (ICTC) of SMS hospital, Jaipur. Simultaneously, CD4+ T-cell count estimation was done to assess the status of HIV infection vis-à-vis parasitic infections. The identification of pathogens was done on the basis of direct microscopy and different staining techniques. RESULTS: Out of 266 patients with diarrhoea, parasites were isolated from 162 (i.e. 60.9%) patients compared to 16 (16%) patients without diarrhoea. Cryptosporidium parvum (25.2%) was the predominant parasite isolated in HIV-positive patients with diarrhoea followed by Isospora belli (10.9%). Parasites were more commonly isolated from stool samples of chronic diarrhoea patients, (77% i.e. 128/166) as compared to acute diarrhoea patients (34% i.e. 34/100) (P<0.05). The maximum parasitic isolation was in the patients with CD4+ T cell counts below 200 cells/µl. CONCLUSIONS: Chronic diarrhoea in HIV-positive patients with CD4+ T-cell counts <200/µl has high probability of association with intestinal parasitic infections. Identification of these parasitic infections may play an important role in administration of appropriate therapy and reduction of mortality and morbidity in these patients.

Prevalence of HIV/AIDS and Prediction of Future Trends in North-west Region of India: A six-year ICTC-based Study.

BACKGROUND: The study was conducted to analyze previous six-year prevalence data of HIV infection in the Northwest region of India and predict future trends for a couple of years. OBJECTIVES: The study was conducted to aid SACS and NACO to plan and arrange resources for the future scenario. MATERIALS AND METHODS: All the attendees of ICTC, Jaipur, from January 2002 to December 2007 were included and variables like age, sex, marital status, occupation, place of residence, pattern of risk behavior and HIV serostatus were studied. As per the strategy and policy prescribed by NACO, tests (E/R/S) were performed on the serum samples. Data was collected; compiled and analyzed using standard statistical methods. Future trends of HIV-prevalence in north-west India were anticipated. RESULTS: The overall positivity rates among attendees of ICTC, were found to be 12.2% (386/3161), 11.8% (519/4381), 11.1% (649/5867), 13% (908/6983), 14% (1385/9911) and 17.34% (1756/10133) in the years 2002, 2003, 2004, 2005, 2006 and 2007 respectively. Future trends for the next couple of years depict further increase in prevalence without any plateau. CONCLUSION: Epidemiological studies should be carried out in various settings to understand the role and complex relations of innumerable behavioral, social and demographic factors, which will help, interrupt and control the transmission of HIV/ AIDS.

Enumeration of CD4 and CD8 T lymphocytes in healthy HIV seronegative adults of northwest India: a preliminary study.

CD4 T lymphocyte count is used to measure the progression of HIV infection and to monitor the response to antiretroviral therapy. Information on reference CD4 and CD8 T cell counts in healthy individuals is lacking in northwest India. Samples from 65 HIV-seronegative healthy volunteers (males, 37; females, 28) aged 18 through 59 years were analyzed using FACS (Fluorescent Antibody Cell Sorter) Count TM System. The values of mean and standard deviation of each lymphocyte subpopulation were estimated. The mean +/- SD of absolute numbers of CD4 and CD8 lymphocytes/microl was 743.4 +/- 307.8 and 541.7 +/- 176.4 in males and 790.7 +/- 280.4 and 497.03 +/- 203.6 in females respectively. The range of CD4 counts was 379 to 1800 in males and 321 to 1265 in females. The mean CD4:CD8 ratio was 1.43 +/- 0.56 in males and 1.78 +/- 0.76 in females. The results of this study show a wide variability in CD4 counts in the Indian population. A large multicentric study would define normal ranges of CD4, CD8, and CD4:CD8 ratios among the Indian population.