Sympatric occurrence of sibling Phytophthora species associated with foot rot disease of black pepper in India

Foot rot disease caused by Phytophthora capsici is a serious threat to black pepper cultivation in India and globally. High diversity exists among the Phytophthora isolates of black pepper and hence detailed investigations of their morphology and phylogenetic taxonomy were carried out in the present study. In order to resolve the diversity, 182 isolates of Phytophthora, collected from different black pepper-growing tracts of South India during 1998-2013 and maintained in the National Repository of Phytophthora at ICAR-Indian Institute of Spices Research, Kozhikode, were subjected to morphological, molecular and phylogenetic characterization. Morphologically all the isolates were long pedicellate with umbellate/simple sympodial sporangiophores and papillate sporangia with l/b ranging from 1.63 to 2.55 µm. Maximum temperature for the growth was ~ 34 °C. Chlamydospores were observed in "tropicalis" group, whereas they were absent in "capsici" group. Initial molecular studies using internal transcribed spacer (ITS) marker gene showed two clear cut lineages-"capsici-like" and "tropicalis-like" groups among them. Representative isolates from each group were subjected to host differential test, multilocus sequence typing (MLST) and phylogeny studies. MLST analysis of seven nuclear genes (60S ribosomal protein L10, beta-tubulin, elongation factor 1 alpha, enolase, heat shock protein 90, 28S ribosomal DNA and TigA gene fusion protein) clearly delineated black pepper Phytophthora isolates into two distinct species-P. capsici and P. tropicalis. On comparing with type strains from ATCC, it was found that the type strains of P. capsici and P. tropicalis differed from black pepper isolates in their infectivity on black pepper. The high degree of genetic polymorphism observed in black pepper Phytophthora isolates is an indication of the selection pressure they are subjected to in the complex habitat which ultimately may lead to speciation. So based on the extensive analysis, it is unambiguously proved that the foot rot disease of black pepper in India is predominantly caused by two species of Phytophthora, viz. P. capsici and P. tropicalis. Presence of multiple species of Phytophthora in the black pepper agro-ecosystem warrants a revisit to the control strategy being adopted for managing this serious disease. The silent molecular evolution taking place in such an ecological niche needs to be critically studied for the sustainable management of foot rot disease.

Evaluation of renal function in children undergoing extracorporeal shock wave lithotripsy

PURPOSE

The effect of extracorporeal shock wave lithotripsy on the growing kidneys of young children has always been a concern. We determined whether shock wave lithotripsy causes renal parenchymal scarring or affects glomerular filtration rate in children.

MATERIALS AND METHODS

This prospective study included 100 children with renal stones who presented to the shock wave lithotripsy unit at our institution between March 2005 and March 2008. A total of 28 children had multiple stones in the same kidney. All children with bilateral renal stones had 1 kidney cleared of stones by percutaneous nephrolithotomy before undergoing shock wave lithotripsy. A total of 138 stones were subjected to shock wave lithotripsy. All children underwent radionuclide scan of the renal parenchyma using dimercapto-succinic acid, and glomerular filtration rate was estimated using diethylenetriamine pentaacetic acid before extracorporeal shock wave lithotripsy and 6 months afterward. Children with renal scarring due to previous surgery or vesicoureteral reflux were excluded from the study. The number of shock wave lithotripsy sessions to achieve stone-free status and the dose of shock waves used were recorded for each patient.

RESULTS

No patient demonstrated renal parenchymal scarring on dimercapto-succinic acid scan or any statistically significant change in glomerular filtration rate on diethylenetriamine pentaacetic acid scan up to 6 months after shock wave lithotripsy.

CONCLUSIONS

Shock wave lithotripsy is a safe modality for treating renal calculous disease in children up to 16 years old, with no impact on long-term kidney function.

Fungal peritonitis caused byBipolaris spicifera

An episode of fungal peritonitis was produced by Bipolaris spicifera in a 3-year-old girl with chronic renal failure secondary to uremic-hemolytic syndrome and who was under treatment with continuous ambulatory peritoneal dialysis (CAPD). Previously, an episode of purulent peritonitis caused by Pseudomonas spp. had been treated successfully with combined antibacterial therapy for 10 days. Microscopic and macroscopic examinations of the freshly collected purulent dialysate were negative for fungal structures and bacteria. The fungus grew from the dialysate plated on Sabouraud dextrose agar and was also macroscopically recognized as a colony attached to the inner wall of the Tenckhoff catheter. Specific cultures of dialysate for common bacteria and mycobacteria were negative. The patient was successfully treated with early catheter removal and empirical administration of 200 mg/day oral fluconazole for 2 weeks. Subsequently, a new catheter was placed and the patient continued well on CAPD. Post-treatment control cultures of dialysate for fungi, bacteria and mycobacteria were negative and the cell count returned to normal.

Confirmation of internal jugular guide wire position utilizing transesophageal echocardiography

PURPOSE

To describe the utility of transesophageal echocardiography (TEE) in confirmation of correct central line J-wire position.

CLINICAL FEATURES

A 51-yr-old male patient presented for urgent coronary artery bypass grafting. Current medications included aspirin, nitroglycerine, heparin and a B-blocker. Physical examination was unremarkable. Initial difficulty with right internal jugular vein cannulation was encountered. A posterior approach was used to access the vein with further difficulty in passing the J-wire. Simultaneous TEE images confirmed the correct J-wire position.

CONCLUSION

The case demonstrates the value of TEE to confirm correct guide wire position prior to insertion of a large bore central venous catheter. TEE visualization of J-wire position avoided repeat attempts at internal jugular cannulation and potential carotid artery puncture.

Diaphragmatic rupture after epidural anaesthesia in a patient with diaphragmatic eventration

An 85-year-old man with undiagnosed eventration of the left hemidiaphragm had an above-knee amputation under epidural anaesthesia. His post-operative course was stormy with two episodes of cardiovascular collapse. On the third post-operative day, rupture of the left hemidiaphragm was diagnosed, the bowel had herniated into the left hemithorax. It is proposed that the left hemidiaphragm ruptured spontaneously because of muscular weakness secondary to the thoracic segmental blockade associated with lumber epidural anaesthesia.

Susceptibility to hemolytic-uremic syndrome relates to erythrocyte glycosphingolipid patterns

Hemolytic-uremic syndrome (HUS) is usually preceded by enteric infection by Shiga-like toxin-producing Escherichia coli (SLT-EC), but most children with SLT-EC diarrhea do not develop HUS. SLT toxicity depends on entry into the target cell via its host cell glycolipid receptor, globotriaosylceramide (Gb3). The relationship between differential susceptibility to HUS and erythrocyte Gb3 levels, as measured by high-pressure liquid chromatography, was studied. Erythrocytes of children with histories of HUS had lower nonhydroxylated fatty acyl (NFA) Gb3 levels than did erythrocytes of controls (1.6 vs. 2.0 nmol/mL of packed cells); these erythrocytes had lower ratios of NFA-Gb3 to lactosylceramide (0.16) than did erythrocytes of SLT-EC diarrheal patients without subsequent HUS (0.30; P < .003) or of healthy controls (0.28; P < .001). The lower erythrocyte Gb3 levels associated with HUS may reflect a genetic predisposition for differential outcomes of SLT-EC gastroenteritis.

Association between severity of gastrointestinal prodrome and long-term prognosis in classic hemolytic-uremic syndrome

To determine whether severity of the prodromal gastrointestinal illness is associated with the course and complications of the extraintestinal manifestations of hemolytic-uremic syndrome, we conducted a retrospective review of children (n = 509) hospitalized with hemolytic-uremic syndrome. Those who came to the hospital with colitis and rectal prolapse associated with hemolytic-uremic syndrome (group I, n = 40) were compared with an equal number of time-matched children with hemolytic-uremic syndrome but without prolapse (group II). Children in group I had evidence of more severe colitis than children in group II had, as indicated by increased frequency of bloody diarrhea (p less than 0.001) and longer duration of diarrhea (p less than 0.001). However, they also had more severe extraintestinal manifestations during hemolytic-uremic syndrome, including edema (p less than 0.0001), severe thrombocytopenia (p less than 0.0001), prolonged anuria (p less than 0.001), and seizures (p = 0.036). Long-term prognosis for recovery of renal function was worse for group I than group II. Within group II, patients with bloody diarrhea had milder extraintestinal illness than those with prolapse but more severe extraintestinal illness than those with watery diarrhea. Analysis of Kaplan-Meier survival curves demonstrated a better prognosis for return of normal renal function in the children with watery diarrhea but without prolapse (p = 0.009) than in children with bloody diarrhea or prolapse. These data demonstrate that the severity of the gastrointestinal prodrome reflects the severity of the extraintestinal acute microangiopathic process and the resulting long-term outcome. Widespread vascular damage, often followed by permanent sequelae, is characteristic of patients with the most severe colitis.