Blastomycosis in a South Indian patient after visiting an endemic area in USA

We describe a case of blastomycosis in a diabetic patient from South India who had visited Milwaukee, Wisconsin, an endemic area for blastomycosis in the USA. After his return to Bangalore, India, the patient developed intermittent fever of moderate to high grade, cough, loss of weight and appetite, and abscesses in the left cubital fossa and thigh regions. Systemic examination at our hospital revealed that he had dullness to percussion over the chest region and decreased breath sounds. Direct examination of Gram-stained smears of the pus from an abscess showed many broad-based budding yeast cells and culture yielded a dimorphic fungus later identified as Blastomyces dermatitidis. Histologic examination of the curettage tissue slides stained with hematoxylin and eosin, periodic acid Schiff's reagent, and Gomori's methenamine silver stain procedures showed many broad-based budding cells characteristic of B. dermatitidis. The patient was successfully treated, initially with amphotericin B, followed by oral itraconazole for a period of 6 months. Blastomycosis cases in India are reviewed and the likely source of infection in this patient is discussed.

An epidemiological evaluation of risk factors for tuberculosis in South India: a matched case control study

SETTING

There are limited data on risk factors associated with tuberculosis (TB) in India.

OBJECTIVES

To evaluate potential socio-demographic risk factors for TB.

DESIGN

Matched case-control. Cases were all new diagnoses of pulmonary TB attending as out-patients at St John's Medical College Hospital, Bangalore, India, from October 2001 to October 2003. Age- and sex-matched controls, one for each case (n = 189), were recruited among relatives accompanying non-TB in-patients in the hospital.

RESULTS

Significant risk factors were low education level (OR 0.30; 95%CI 0.11-0.82), not having a separate kitchen (OR 3.26; 95%CI 1.25-8.46) and chronic disease, mainly diabetes (OR 2.44; 95%CI 1.17-5.09). High income, cooking with biomass fuels, history of smoking and alcohol consumption were not significant on multivariate analysis. Patients were respectively 11 and seven times more likely to have a BMI <18.5 (95%CI 5.62-21.98) and mid-arm circumference <24 cm (95%CI 3.87-11.89).

CONCLUSIONS

In our study, TB was associated with low education level, kitchen type and diabetes, reflecting the complex interaction between non-communicable disease, urbanisation and a changing economic climate in Bangalore. The relationship between TB, the use of biomass cooking fuels and gender differentials related to fuel exposure merit further exploration. The study underscores the poor nutritional status of patients.

Laparoscopic intervention in resistant hepatosplenic tuberculosis presenting as pyrexia of unknown origin

Hepatosplenic tuberculosis (HST), rarely encountered in surgical practice, is seen in-patients with disseminated tuberculosis. A 20-year-old female presenting with pyrexia of unknown origin (PUO) was subsequently diagnosed to have lymph-nodal tuberculosis with involvement of liver and spleen. Despite anti-tuberculosis treatment (ATT) for 3 months, clinical improvement did not occur and fever persisted. Laparoscopic splenectomy and drainage of the hepatic cold abscess were done with favorable results. Smear for acid fast bacilli (AFB), culture for Mycobacterium tuberculosis and histopathological examination (HPE) established the diagnosis of tuberculosis (TB).

Cross-sectional survey of the extent and indicators of hepatitis C virus infection in Houston Department of Health and Human Services' sexually transmitted disease clinics

To evaluate the prevalence and indicators of hepatitis C virus (HCV) infection in Houston and determine the effectiveness of targeted HCV screening in sexually transmitted disease (STD) clinics. We performed a cross-sectional survey in low-risk and high-risk groups in Houston. This included a blinded survey of HCV conducted in 1010 STD clinic clients having serological syphilis tests, and 1885 multi-speciality group practice patients having metabolic blood work. This was followed with a targeted hepatitis C survey of 822 high-risk clients from STD clinics. The seroprevalence of hepatitis C infection in the blinded survey was 3.9% (95% CI 3.0-4.8) in the multi-speciality group and 5.0% (95% CI 3.7-6.3) in the STD clinics. Prevalence of hepatitis C infection among targeted STD clinic clients was significantly higher at 15.3% (95% CI 12.7-17.7). Risk factors that correlated with HCV infection after logistic regression included: injection drug use (OR = 10, 95% CI = 3.4-30.3), heroin use (OR = 6.6, 95% CI = 2.2-20.5), non-transfusion/ transplantation blood exposure (OR = 3.0, 95% CI = 1.3-6.9), sharing equipment to snort drugs (OR = 2.5, 95% CI 1.2-5.4), and age above 25 years (OR = 51, 95% CI = 9-47). This study demonstrates that targeting clients in STD clinics for known risk behaviours is an effective way to identify cases of HCV infection. STD clinics allow access to clients with both drug use and sexual risk behaviours and are a useful location for targeting hepatitis C screening and prevention efforts.

Tay-Sachs disease carrier screening: a 21-year experience

This paper presents the findings of a community-based carrier screening program for Tay-Sachs disease, initiated on the University of Wisconsin-Madison campus in 1978. The Madison Community Tay-Sachs Screening Program (MCTSSP) is a collaborative, interdisciplinary program that organizes and conducts periodic screening for Tay-Sachs disease (TSD) for the purpose of identifying Tay-Sachs carriers. We present and analyze data on carrier detection with regard to various demographics, including family history of TSD, ancestry, gender, medication exposure, and illness. Individuals participating in the MCTSSP between 1978 and 1999 were primarily of the target population, and the carrier rate was within the expected range (1/25). Despite aggressive publicity efforts and a well-established program, attendance at the screens has declined. A recent survey of Jewish undergraduate students at the University of Wisconsin-Madison showed poor recall of family screen history and carrier status and reinforced the perception that utilization of the Madison screening program has been low. Ways to increase awareness of and interest in carrier screening for TSD are explored.

Bronchoalveolar lavage--cellular characteristics in patients with idiopathic pulmonary fibrosis and sarcoidosis

Bronchoalveolar lavage (BAL) was carried out in 30 patients of idiopathic pulmonary fibrosis (IPF), 10 patients of sarcoidosis and 10 normal subjects who served as controls. The total cell counts were higher both in the IPF (24.8 x 10(5)/ml) and sarcoidosis (19.3 x 10(5)/ml) as compared to the normal controls (9.8 x 10(5)/ml). The difference was statistically significant in both the groups (p less than 0.001 and less than 0.05 respectively). Patients with IPF showed a predominant polymorphonuclear response although the lymphocytes were also increased whereas patients of sarcoidosis had a lymphocytic response in the BAL fluid. In 6 patients with IPF the study was repeated after 6 weeks of steroid therapy and a decrease in the total cell count and polymorphonuclear cells (%) was noted.

Transbronchial lung biopsy in diffuse lung disease--a study of 28 cases

Twenty-eight patients with diffuse lung disease underwent transbronchial lung biopsy during fibreoptic bronchoscopy. In 26 patients (93%) adequate tissue was obtained. Of these 26 biopsies specific diagnosis was possible in 20 (76%); a further 2 had non-specific inflammatory changes and a third, who was clinically normal, had normal lung. The inclusion of these cases raises the yield to 88%. The conditions most frequently seen were interstitial fibrosis (35%) and granulomatous diseases (31%). Three patients (11%) had procedure related pneumothorax; only one required a chest tube. This is a high yield, safe procedure and should be used more widely in India.