Pattern of onychomycosis--a RIMS study.

Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts or non-dermatophytes moulds. In this study, 500 patients suspected of having onychomycosis reffered from the out patient department (OPD), Dermatology, Regional Institute of Medical Sciences (RIMS) Hospital Imphal Manipur during the period from January 2007 to December 2008 were processed in the Department of Microbiology RIMS. Nail clippings or scrapings depending on the variety of onychomycosis were collected with sterile blades under all aseptic measures. Specimens were put up for 10% KOH mount, fungal cultures on two sets of SDA (Sabouraud's dextrose agar) incorporated with antibiotics and lactophenol cotton blue preparation (LCB) from the cultures and examined microscopically. Slide cultures were also put up if necessary. Out of 500 samples processed, a total of 444 (88.8%) were positive for the various fungi. The positive fungi were dermatophytes 258 (58.1%), non-dermatophytes 139 (31.3%), yeasts and yeast-like 17 (3.8%) and mixed fungal isolates 30 (6.7%). Of the 230 males and 270 females studied,193 (83.9%) males and 251 (92.9%) females respectively were positive for various fungi causing onychomycosis. Maximum number of suspected cases were in the age group of 21-30 years. Among the dermatophytes, Trichophyton species (spp.) 250 (50%) was the commonest isolate followed by Epidermophyton spp. 8 (1.6%). Among the non-dermatophytes, Aspergillus spp. 70 (14%) was the commonest followed by Penicillium spp. 24 (4.8%), Acremonium spp. 9 (1.8%), Fusarium spp. 8 (1.6%), Curvularia spp. 7 (1.4%), Alternaria spp. 5 (1%), Scopulariopsis spp. 4 (0.8%), Cladosporium spp. 4 (0.8%), Nigrospora spp. 2 (0.4%), Mucor spp. 1 (0.2%), Paecilomyces spp. 1 (0.2%), Pseudallescheria spp. (0.2%), Rhizopus spp. 1 (0.2%), Verticillium spp. 1 (0.2%), Exophiala jeanselmei 1 (0.2%). Among the yeast and yeast-like i.e. Candida spp. 15, Geotrichum spp. 1, Rhodotorula spp. 1 were 17 (3.8%), mixed fungal isolates 30 (6.7%), respectively. Reports were given to the patient for follow up and treatment. Health awareness and suggestions were given for prevention and further spread of onychomycosis.

Strongyloides stercoralis infection in an HIV positive patient--a case report from RIMS, Imphal, Manipur.

Strongyloides stercoralis, a nematode parasite in human with free living and autoinfective cycles, is often an asymptomatic infection of the upper small intestine. If the host becomes immunocompromised, autoinfection may increase the intestinal worm burden and lead to disseminated strongyloidiasis. We report a case of a 33 year old male HIV positive patient admitted on 2/6/08 in male medical ward, Regional Institute of Medical Sciences, Imphal, Manipur with complaints of loose stools, pain abdomen, nausea, vomiting, generalized weakness, loss of appetite and loss of weight for past one month with fever off and on. Stool examination reveals larvae of Strongyloides stercoralis. The patient was successfully treated with Ivermectin 200 microgm/kg daily for 2 days.

Co-infection of herpes simplex virus (HSV) with human immunodeficiency virus (HIV) in women with reproductive tract infections (RTI).

In India, HSV seroprevalence and its coinfection with HIV among female patients with reproductive tract infections (RTI) are sparse. We aim to ascertain the seroprevalence of HSV and its coinfection with HIV and common sexually transmitted infections attending Obstetrics and Gynaecology outpatient department, RIMS. The study included 92 female patients with RTI. Diagnostic serology was done for HSV-1 and HSV-2 using group specific IgM indirect immunoassay using ELISA, HIV by 3 ELISA/Rapid/Simple (E/R/S) test of different biological antigen. Diagnosis of RTI was made on clinical grounds with appropriate laboratory investigations--microscopy, Gram stain smear etc. Bacterial vaginosis was diagnosed using Nugent's criteria, Syphilis by rapid plasma reagin (RPR) card test and Chlamydia trachomatis by IgG ELISA. Out of 92 sera tested for HSV, 18 (19.6%) were IgM HSV positive and 9 (9.8%) were HIV positive. Co-infection rate of HSV in HIV positive was 16.7%. None of the patients had clinical herpes genitalis, all were subclinical cases. 55.5% of HSV positives belongs to age group 21 to 30 years. Of the HSV-1 and HSV-2 IgM positives 3 (15%) had HIV, 4 (22.2%) bacterial vaginosis, 2 (11.1%) were RPR positive, 4 (22.2%) Chlamydia trachomatis, 3 (15%) were pregnant. 16 (88.8%) were unemployed, 14 (77.7%) had education level below 10 standard. Our study suggest that every case of RTI, be it an ulcerative or nonulcerative must be thoroughly evaluated by laboratory testing for primary subclinical genital HSV coinfection as this has profound implications on their judicious management and aversion of complications. Early diagnosis and treatment of HSV infection together with prophylaxis for recurrent HSV disease will prevent progression and spread of HIV disease.

Pattern of hepatitis C virus genotypes in HIV infected patients in RIMS, Hospital, Imphal, Manipur.

The present study was carried out to find the pattern of genotype distribution of Hepatitis C virus. Twenty-three Hepatitis C virus positive serum samples in various age-groups of both sexes attending, Microbiology Department, RIMS during the period from September 2002 to December 2004 were studied for Hepatitis C genotype. These HCV positive serum samples were sent to National Institute of Cholera and Enteric Diseases, Kolkata. The serum samples were tested for HCV-RNA by qualitative RT-PCR test and then genotyped by type specific RT-PCR. Out of 23 serum samples, 22 were males. All the 23 HCV positive serum samples were also tested positive for HCV-RNA by qualitative RT-PCR. Majority of the cases belonged to the age group of 31-40 years. Higher percentage of Hepatitis C cases were Injecting Drug Users and next to it were patients with multiple sexual contacts. Among the IDUs, Hepatitis C virus 3a type was the commonest genotype (61.1%) followed by 1b (22.2%) and 3b (16.7%) respectively. Hepatitis C genotype 3a was predominant (52.2%) followed by 1b (26%) and 3b (21.8%). HCV genotype 3a occurred most commonly in the age group of 21-40 years.

Increasing trend of HIV seropositivity among commercial sex workers attending the Voluntary and Confidential Counseling and Testing Centre in Manipur, India.

A total of 1903 commercial sex workers (CSWs) attending the Voluntary and Confidential Counseling and Testing Centre at the Department of Microbiology, Regional Institute of Medical Sciences, Manipur, were screened for HIV infection over a period of five years from March 1998 to February 2003. All cases were in the age group 13-55 years. Most cases were in the age group 20-30 years (50.86%). Out of 1903 CSWs, 304 were found to be HIV-seropositive, confirmed by three tests (ELISA/RAPID/SIMPLE) of different biological antigen principles according to India's National AIDS Control Organisation guidelines. The annual rising trend in incidence of HIV seropositivity among CSWs from March 1998 (10.93%) to February 2003 (29.68%) was observed in the test site attenders, in contrast to the declining trend among injecting drug users in the state from March 1998 (76%) to February 2003 (59.82%). In all, 622 sexually transmitted infection (STI) cases were diagnosed, of which 242 (38.90%) had syphilis, which was the commonest STI, and 172 (27.65%) had ulcerative lesions. Increasing HIV seropositivity among CSWs observed in this study reflects the changing pattern of HIV transmission in Manipur.

Pulmonary paragonimiasis.

A 27-year-old married male from Lamdeng village of Imphal West District, Manipur presented with cough, fever, haemoptysis, anorexia and weight loss, and was treated with antituberculosis drugs continuously for one year without improvement. He also had history of ingestion of raw crabs. Chest radiograph revealed right midzone lesion with cavitation. Laboratory investigations revealed peripheral blood eosinophilia, elevated erythrocyte sedimentation rate and sputum smear revealed eggs of Paragonimus westermani. He responeded well to treatment with praziquantel 25 mg/kg, three times a day for three days and is doing well on follow-up. Pulmonary paragonimiasis must be considered in the differential diagnosis of slowly resolving pneumonias, especially in the appropriate clinical setting because effective treatment with praziquantel can be rewarding.

Helminthic infestation of the primary school-going children in Manipur.

A total of 1010 stool samples collected from the primary school-going children between the age group of 5 to 10 years from September 1998 to October 2000, were studied to find out the prevalence of intestinal helminths in this paediatric age group and in the urban and rural areas of Manipur. The samples were processed in the Microbiology Department, RIMS, Imphal by wet film, iodine preparation and concentration techniques (formol-ether concentration) to find out the presence of eggs, larvae of the intestinal parasites (helminths). A total of 248 (24.5%) were positive for various helminths. Among the positive cases, 110 (26.3%) were from the urban area (city) and 138 (23.4%) from the rural areas of Manipur. Of the 552 males and 458 females tested, 136 (24.6%) males and 112 (24.5%) females respectively were positive for various helminths. Maximum number of parasitic infection occurred in the age group of 5 to 6 years (27.0%) in both sexes. Among the parasites, Ascaris lumbricoides was the commonest (19.6%) followed by Trichuris trichiura (2.18%), Hymenolepis nana (0.99%), Tapeworm (0.19%), Hookworm (0.09%), Strongyloides stercoralis (0.09%), Enterobius vermicularis (0.09%). Mixed infection of Ascaris lumbricoides with T. trichiura (1.08), T. trichiura with E. vermicularis (0.09%) and T. trichiura with S. stercoralis (0.09) were also encountered. Antihelminthic drugs were prescribed to those who were found positive for the helminths.

Prevalence of HIV infection and AIDS symptomatology in malnourished children--a hospital based study.

One hundred and seventy five malnourished children aged between 1(1/2) and 12 years attending pediatric department of Regional Institute of Medical Sciences Hospital, Imphal from January 2001 to June 2002 were screened for human immunodeficiency virus (HIV) infection along with their biological mothers after pretest counselling and informed consent. The prevalence rate of HIV seropositivity among malnourished children was 21.7%. Children aged between 1(1/2) and 3 years had the highest seroprevalence (47.4%) and male to female ratio was 1.5: 1. Underweight children showed the highest seroprevalence (47.4%) and children with kwashiorkor showed least seroprevalence (10.5%). Mode of HIV transmission was vertical in 94.7%. The causative agent was HIV-I in all the cases. AIDS defining children features were seen more frequently among HIV seropositive malnourished children as compared to the seronegative children. Prolonged fever (p 0.001), oropharyngeal candidiasis (p<0.001), generalised lymphadenopathy (p<0.001) and disseminated maculopapular dermatitis (p<0.001) were significantly related to HIV infection. Among seronegative children 18.2% fulfilled the clinical criteria for AIDS and among seropositive children 94.7% had AIDS. The total mortality encountered among seropositive children was 34.2%. It is suggested to confirm findings based on larger community based data before recommending mandatory HIV testing in all malnourished children. Specific guidelines on the nutritional management of children with HIV/AIDS is needed in Manipur where HIV is spreading rapidly.

Diversity of circulating rotavirus strains in children hospitalized with diarrhea in India, 2005-2009.

BACKGROUND: India accounts for 22% of the 453,000 global rotavirus deaths among children <5 years annually. The Indian Rotavirus Strain Surveillance Network provides clinicians and public health partners with valuable rotavirus disease surveillance data. Our analysis offers policy-makers an update on rotavirus disease burden with emphasis on regional shifts in rotavirus strain epidemiology in India. METHODS: Children <5 years requiring hospitalization for acute gastroenteritis were selected from 10 representative hospitals in 7 cities throughout India between November 2005 through June 2009. We used a modified World Health Organization protocol for rotavirus surveillance; stool specimens were collected and tested for rotavirus using enzyme immunoassay and reverse-transcription polymerase chain reaction. RESULTS: A total of 7285 stool specimens collected were tested for rotavirus, among which 2899 (40%) were positive for rotavirus. Among the 2899 rotavirus detections, a G-type could not be determined for 662 (23%) and more than one G type was detected in 240 (8%). Of 1997 (69%) patients with only one G-type, the common types were G1 (25%), G2 (21%), G9 (13%), and G12 (10%). The proportion of rotavirus infections attributed to G12 infections rose from 8% to 39% in the Northern region and from 8% to 24% in the Western region. CONCLUSIONS: This study highlights the large, ongoing burden of rotavirus disease in India, as well as interesting regional shifts in rotavirus strain epidemiology, including an increasing detection of G12 rotavirus strains in some regions. While broad heterotypic protection from rotavirus vaccination is expected based on pre- and post-licensure data from other settings, effectiveness assessments and rotavirus strain monitoring after vaccine introduction will be important.

Surveillance and molecular characterization of rotavirus strains circulating in Manipur, north-eastern India: increasing prevalence of emerging G12 strains.

To determine the frequency and genotypes of rotavirus strains, samples were collected from children hospitalized with acute diarrhea at the Regional Institute of Medical Sciences, Manipur. The globally common genotypes G1P[8] and G2P[4] constituted 58% of the total positive strains, while 3% and 8% strains were emerging genotypes, G9P[6] and G12P[6]. This is the first report of genotype G12 in Manipur. The G12 strains clustered with lineage III strains and had >98% identity with corresponding rotaviruses from Bangladesh, Thailand and the USA. Other uncommon G-P combinations including G4P[4], G4P[6], G10P[6] and G9P[19], along with a few strains that could not be typed were also found. The VP7 genes of G4 and G10 strains clustered with porcine and bovine strains, indicating possible zoonotic transmission. High frequency (36-62%) of rotavirus infection and predominance of G1P[8] and G2P[4] among children with acute diarrhea emphasized the need for implementation of currently available vaccines to reduce the burden of rotavirus induced diarrhea in India.

Coinfection by human immunodeficiency virus, hepatitis B virus and hepatitis C virus in injecting drug users.

Detection of hepatitis B surface antigen (HBsAg), anti hepatitis C virus (HCV) antibody and anti human immunodeficiency virus (HIV) antibody was carried out in serum samples from 250 injecting drug users (IDUs) from a deaddiction centre, Shalom, in Churachanpur district, Manipur during the period of August-October, 2002. One hundred and forty-nine (59.6%) IDUs were positive for HIV antibody, 226 (90.4%) were positive for anti HCV antibody and 27 (10.8%) were positive for HBsAg. There was coinfection of HIV, hepatitis B virus (HBV) and HCV in 15 (6%) of the IDUs. The coinfection of HBV and HCV was found in 12 cases (4.8%) and coinfection of HIV and HCV was found in 131 cases (52.4%). HIV and HCV were the highest among the coinfection of IDUs. The IDUs were in sexually active age group with a risk of infection to their sexual partner.

Penicillium morneffei, an emerging AIDS-related pathogen--a RIMS study.

Twenty-seven HIV-infected patients with penicilliosis were included to study the clinical, laboratory and therapeutic features of HIV-infected patients with disseminated Penicillium marneffei infection. Diagnosis was based on microscopy and culture. CD4 counts were assessed by flow cytometry. Males (23 out of 27) predominated while the ages ranged from 20 to 54 years (mean 31.5 years). The most common manifestations were fever, weight loss, anaemia and skin lesions. CD4 counts were low in all the patients. The response to treatment with intravenous amphotericin B followed by itraconazole was excellent. Penicillium marneffei has become an important opportunistic pathogen of HIV infection in Manipur. Penicilliosis should be considered in a susceptible patient with a non-specific febrile illness, a low CD4 count and molluscum contagiosum-like skin lesions. Early diagnosis and treatment improve survival.

Head and neck manifestations of HIV infection: a preliminary study.

The study deals with evaluation of the head and neck manifestations of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). It is a preliminary, prospective study, conducted in the department of ENT and microbiology, Regional Institute of Medical Sciences, Imphal, Manipur. The clinical presentations for HIV infection and AIDS with head and neck involvement are shown in this paper. Forty patients with HIV infection and various head and neck manifestations are included in this study The median age of diagnosis was 33 years with male to female ratio of 3.4: 1. The predominant mode of transmission of HIV infection among the patients of this series was found to be intravenous drug use (IDU) in 65% of cases. Rhinosinusitis was found to be the most common presenting feature constituting 27.5% of the cases followed by oral candidiasis in 22.5% of the cases. After consideration and observation of all the facts and findings, this study concludes and proposes that it will be well for all clinicians, including otolaryngologists especially, to bear a high level of suspicion for HIV infections in their day to day practice.