Paratyphoid fever- Emerging problem in South India

Objective:To review the clinical profile and drug susceptibilities of Salmonella paratyphi A in a tertiary care hospital.Methods:Retrospective analyses of 113 patients with paratyphoid fever and 101 culture proven Salmonella paratyphi A infection were included in the study.The study extended over a period of 3 years(2006-2008).Diagnosis of patients were based on clinical features,serology and blood culture.The drug susceptibility testing of the isolates were performed by the disc diffusion method.Clinical presentation,laboratory parameters,susceptibility patterns of isolates,treatment and clinical response were studied.Results:Of the 113 cases,77(68.4%) were males and 36 were females(32.8%),which included 2 pediatric patients.Fever was the most common symptom(100.0%) followed by loose stools(37.2%),headache(35.4%),myalgia(31.9%), pain abdomen(29.2%),dry cough(19.5%) and vomiting(13.3%).All patients were clinically cured. Majority of the isolates(46%) were resistant to cotrimoxazole in 2006,however they became 100% sensitive in 2007 and 2008.whereas the strains became 100% sensitive to ampicillin and chloramphenicol only in 2008.In 2006 the sensitivity of organisms to ciprofloxacin was 89% but in 2007 and 2008 there has been an increasing resistance to ciprofloxacin(46% and 86%) respectively.Surprisingly 3 isolates(8.1%) were resistant to ceftriaxone in 2006,showed 100% sensitivity in 2008.Common drugs used were ceftriaxone in 100 cases(88.4%) and ciprofloxacin in 13 cases(11.6%).One patient had relapse of paratyphoid fever after treatment with ciprofloxacin which responded to ceftriaxone.Conclusions:Paratyphoid fever A is one of the emerging infections and a significant problem in India.An increasing resistance to fluoroquinolones is noted.Continuous monitoring of drug susceptibilities is mandatory in instituting appropriate therapy.

Clinical profile of disseminated cryptococcal infection-a case series

Objective:To study disseminated cryptococcal infection in a tertiary care hospital in Southern India.Methods:The clinical profile of 12 disseminated cryptococcosis patients with the age group of 28-52 years was retrospectively analyzed.Results:7(58.3%) presented with fever 【 30 days and 3(25%) 】 30 days whereas 2(16.7%) did not have fever.All the 12(100%) had headache. 2(16.7%) had altered sensorium,one(8%) seizure.5(41.7%) had diarrhea and vomiting.6(50%) had oral candidiasis,and anemia.9(75%) had elevated erythrocyte sedimentation rate(ESR).6(50%) had neck stiffness.Cerebrospinal fluid(CSF) pressure was elevated in all 12(100%) patients. Blood culture positive for Cryptococcus neqformans(C.neoformans) in 11(91.7%) and CSF culture positive in all 12(100%),one(8%) had urine culture positive.India ink preparation was positive in 10(83.3%).CD4 count was less than 50/microl in 4(33.3%),between 50-100 in 6(50%) and 2(16.7%) in the range of 100-200.6(50%) were treated with parenteral amphotericin B(0.7 mg/kg/d) during intensive phase followed by oral fluconazole 400 mg/d for 8 weeks then maintenance oral fluconazole 200 mg/d.5(41.6%) were treated with fluconazole alone.8(66.7%) improved and 4(33.3%) patients died.Among those who succumbed to the illness,2(16.7%) received amphotericin and fluconazole,2(16.7%) patients received fluconazole alone.Conclusions:Disseminated cryptococcosis can cause considerable mortality in HIV patients and immunocompromised non- HIV individuals.At times,its presentation closely mimics that of Tuberculosis.Early diagnosis and appropriate treatment should be started as early as possible.