Cutaneous trichosporosis

Of 269 patients with cutaneous trichosporosis a majority of 170 (63.2%) showed the infection as intertrigo in the genitocrural and perianal areas. The predominant symptoms were itching and burning. Trichosporosis has been found to be less common in the other sites. Trichosporosis due to Trichosporon beigelii should be kept in mind as one of the differential diagnosis in cases of genitocrural intertrigo and other cutaneous infections by fungi and bacteria in the tropics.     

Tinea capitis an endemic disease in Madras

A study ofTinea capitis in Outpatient Clinic, Skin Department, Government General Hospital, Madras during a three year period from November, 1973 to October, 1976, has shown a gradual increase in incidence of 3.56%, 5.09 % and 6.25 % respectively. Findings suggest thatTinea capitis is endemic in South India. Male children were more commonly affected than female children and the age groups chiefly affected were between 5 and 10 years. A considerable number of adults were also affected. The disease showed no correlation to environmental temperature, humidity and rainfall but was correlated to all types of mycoses and total incidence of mycoses.Among 357 isolates,Trichophyton violaceum was the commonest in 264 (73.94%) andT. tonsurans was the next common in 47 (13.16%). The other agents wereT. rubrum in 30 (8.4%),T. mentagrophytes in 11 (3.08%) andT. simii in 5 (1.4%). Noninflammatory lesions were more common than inflammatory lesions and both were produced byT. violaceum andT. tonsurans, suggesting strain differences in pathogenesis. Treatment with oral griseofulvin was satisfactory in all but had to be discontinued in 4 patients due to side effects.     

A study of 3891 cases of mycoses in the tropics.

4103 cases suspected of mycoses were analysed as to sex, age and site of disease and 3891 were proved cases. This group formed 50% of total mycoses or 13-93% of all dermatoses recorded in the Government General Hospital, Madras, during the period of study. There were 66-26% adult female, 27-6% adult male and 6-14% were below 13 years. Dermatophytoses were found in 73-5%; the other common diseases were tinea versicolor (17-68%) and candidiasis (12-43%). Multiple sites of involvement or more than 1 disease in the same individual were mostly observed. The incidence of piedra (0-1%) and deep mycoses (0-156%) was very low. Mycetoma was the common disease (5/6) in deep mycoses. In dermatophytoses, tinea corporis (49-71%) and tinea cruris (47-85%) commonest; tinea axillaris (3-42%), tinea capitis (1-72%) and tinea barbae (1-29%) were less common. The incidence of tinea manuum, tinea pedis and tinea unguium was similar (4-97%-6-38%). High temperature and humidity were related to the higher incidence of tinea corporis, tinea cruris and tinea versicolor. Mainly children suffered from tinea capitis. All other mycoses were commonly found in adults between 2nd and 3rd decades. In all mycoses but candidiasis, female predominated. Cutaneous candidiasis was mainly a problem of housewives. Among the dermatophytes Trichophyton violaceum was predominant (33-7%) followed by T. rubrum (32-6%). Trichophyton schoenleinii and M. gypseum were rarely isolated. From mycetoma, Madurella mycetomii, Nocardia braziliensis, N. asteroides and Actinomadura spp. were isolated. Demonstration of Cryptococcus laurentii in 1 case is reported in this area for the first time.     

Lymph node invasion by Conidiobolus coronatus and its spore formation in vivo

Lymph node invasion with presence of conidia, their replicates, germ tubes, condidia with hair-like projections and hyphae have been observed in a case of entomophthoromycosis caused by Conidiobolus coronatus. This rare occurrence of conidia with hair-like projections that is usually observed in vitro, has been observed in vivo, in the content of an abscess produced by this agent, C. coronatus in the present case. Severe disfigurement and destruction of facial and nasopharyngeal tissues, have also been observed in this case. Response to therapy with oral KI, surgery, combinations of trimethoprim and sulphamethoxazole and steroids though found useful initially, was ineffective subsequently as the disease progressed over 7 years. Findings of lymphatic invasion and the extensive destruction observed in the present case warrants a guarded prognosis. Free conidial reproduction found in lymph nodes may suggest the possibility of this disease being infectious, requiring an active and vigorous treatment schedule and control measures in this infection.     

Adiaspiromycosis of human skin caused by Emmonsia crescens

Two cases of cutaneous adiaspiromycosis by Emmonsia crescens are reported. This is the first human skin infection by this species and is the first report of its kind in man from India. In the first patient, the agent was demonstrated in KOH mounts, histology and culture from irregular, pigmented skin plaques on the right gluteal area. The lesion also contained calcium. In the second patient the fungus was demonstrated histologically in a knee lesion. The agent had elicited a histiocytic and giant cell reaction in the dermis in both cases. The first patient suffered from anaemia and epilepsy and the second suffered from nephropathy with chyluria. The skin lesions were surgically excised with skin grafting in the first patient.     

HLA-A*7401-mediated control of HIV viremia is independent of its linkage disequilibrium with HLA-B*5703

The potential contribution of HLA-A alleles to viremic control in chronic HIV type 1 (HIV-1) infection has been relatively understudied compared with HLA-B. In these studies, we show that HLA-A*7401 is associated with favorable viremic control in extended southern African cohorts of >2100 C-clade-infected subjects. We present evidence that HLA-A*7401 operates an effect that is independent of HLA-B*5703, with which it is in linkage disequilibrium in some populations, to mediate lowered viremia. We describe a novel statistical approach to detecting additive effects between class I alleles in control of HIV-1 disease, highlighting improved viremic control in subjects with HLA-A*7401 combined with HLA-B*57. In common with HLA-B alleles that are associated with effective control of viremia, HLA-A*7401 presents highly targeted epitopes in several proteins, including Gag, Pol, Rev, and Nef, of which the Gag epitopes appear immunodominant. We identify eight novel putative HLA-A*7401-restricted epitopes, of which three have been defined to the optimal epitope. In common with HLA-B alleles linked with slow progression, viremic control through an HLA-A*7401-restricted response appears to be associated with the selection of escape mutants within Gag epitopes that reduce viral replicative capacity. These studies highlight the potentially important contribution of an HLA-A allele to immune control of HIV infection, which may have been concealed by a stronger effect mediated by an HLA-B allele with which it is in linkage disequilibrium. In addition, these studies identify a factor contributing to different HIV disease outcomes in individuals expressing HLA-B*5703.     

Black grain mycetoma — 2 case reports

Two cases of black grain mycetoma, one owing to Madurella grisea and the other due to M. mycetomii have been reported. The clinical features appear to be less florid than that occurring in actinomycotic mycetoma. There was no bone involvement in either of the two cases. These two are the first cases of black grain mycetoma from our institution.     

A pilot study on the association between SLCO1B1 RS4363657 polymorphism and muscle adverse events in adults with newly diagnosed dyslipidaemia who were prescribed a statin: the Malaysian primary health care cohort

Abstract

Introduction: Statin, the first-line treatment for dyslipidaemia, may have suboptimal adherence due to its associated muscle adverse events. These data, however, remain limited.

Aim: To determine the association of serum creatine kinase (CK) and SLCO1B1 rs4363657 polymorphism with statin-associated muscle adverse events (SAMAE) among dyslipidaemia participants.

Methods: This was a prospective cohort study at government health clinics involving newly diagnosed adults with dyslipidaemia. SAMAE were recorded based on the patient’s complaint after a month on statin. CK was taken at baseline and follow-up. Genetic profiling was performed for SLCO1B1 rs4363657 polymorphism.

Results: Among 118 participants, majority were Malay (72%) males (61%) with a mean age of 49?±?12.2 years old and prescribed lovastatin (61.9). There was a significant association between statin types (lovastatin and simvastatin) and SAMAE (p?=?0.0327); no significant association noted between CK and SAMAE (p?=?0.5637). The SLCO1B1 rs4363657 polymorphism was significantly associated SAMAE (p?<?0.0001).

Conclusions: In this first pilot study of a multiethnic Malaysian population, the incidence of SAMAE was 18.6%. SAMAE were significantly higher in subjects on lovastatin compared to simvastatin. SLCO1B1 rs4363657 polymorphism was a significant risk factor for SAMAE.     

Paronychia and black discoloration of a thumb nail caused by Curvularia lunata

Chronic paronychia associated with black discoloration of the left thumb nail in a 51 year old female caused by Curvularia lunata is reported for the first time. The keratolytic activity of the fungus in the nail and its complete clearance by topical clotrimazole are reported.