The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Fungal diseases represent an important paradigm in immunology, as they can result from either a lack of recognition by the immune system or overactivation of the inflammatory response. Research in this field is entering an exciting period of transition from studying the molecular and cellular bases of fungal virulence to determining the cellular and molecular mechanisms that maintain immune homeostasis with fungi. The fine line between these two research areas is central to our understanding of tissue homeostasis and its possible breakdown in fungal infections and diseases. Recent insights into immune responses to fungi suggest that functionally distinct mechanisms have evolved to achieve optimal host-fungus interactions in mammals.

Immunity to Fungal Infections

http://academic.oup.com/milmed/article-pdf/146/1/60/24125826/milmed-146-1-60.pdf

Biochemical Tests for Identification of Medical Bacteria

病毒性肺炎常为吸入性感染,主要传染源是病人,通过飞沫和密切接触传染,可由上呼吸道病毒感染向下蔓延引起,也可继发于出疹性病毒感染,常伴气管-支气管感染.流行性感冒病毒是成年人和老人病毒性肺炎最为常见的病原,婴幼儿病毒性肺炎则常由呼吸道合胞病毒感染所致.其他如副流感病毒、巨细胞病毒、冠状病毒、腺病毒、鼻病毒和某些肠道病毒,如柯萨奇、埃可病毒等也可引起病毒性肺炎.在非细菌性肺炎中,病毒性肺炎占25%～50%,多发生于冬春季节,可散发或流行,多见于婴幼儿、老年人和原有慢性心肺疾病的病人.近年来由于免疫抑制药物广泛应用于器官移植病人,以及爱滋病发病人数的增多,病毒性肺炎的发病率逐渐增多,而SARS的流行使得病毒性肺炎显得尤为重要.一般的病毒性肺炎临床表现大多轻微,与支原体肺炎症状相似,病程1～2周.但重症肺炎可有持续高热、心悸、气急、呼吸困难、发绀,还可伴有休克和呼吸衰竭。

Viral pneumonia

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)60229-9/pdf

ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others

Unusual fungal agents that exist environmentally as saprophytes can often lead to opportunistic infections. Hyalohyphomycosis is a group of fungal infections caused by fungi characterized by hyaline septate hyphae and can infect both immunocompetent as well as immunocompromised patients. Many a times it becomes difficult to distinguish a pathogenic and a contaminant fungus, because many such agents can assume clinical significance depending on circumstances. Subcutaneous and invasive fungal infection due to the emerging hyalohyphomycotic fungus, Acremonium, has drawn the attention of clinicians and microbiologists, as a potential pathogen in patients with and without underlying risk factors. Generally considered to be minimally invasive in the past, genus Acremonium has been responsible for eumycotic mycetomas and focal infections in otherwise healthy individuals. It has also been increasingly implicated in systemic fungal diseases. The management with different antifungals in various clinical situations has been very conflicting and hence needs to be carefully evaluated. This overview is an endeavor to consolidate the available clinical infections due to Acremonium and the recommendations on treatment.

Acremonium Species: A Review of the Etiological Agents of Emerging Hyalohyphomycosis

Background & objective Corneal blindness is a major health problem worldwide and infectious keratitis is one of the predominant causes. The incidence of fungal keratitis has increased over the last few years. Though a few studies have been carried out on mycotic keratitis from north and other parts of India, there are none from Delhi. Keeping this in mind, this study was conducted to evaluate the frequency of positive fungal cultures in infectious keratitis and of the various fungal species identified as aetiologic agents in patients attending a tertiary care hospital in East Delhi. Methods Corneal scrapings from 346 patients of corneal ulcer with suspected fungal aetiology were subjected to direct examination by 10 per cent KOH mount, Gram stain and culture. The results were examined retrospectively and analyzed. Results Of the 346 patients of corneal ulcer investigated, in 77 (22.25%) cases fungal aetiology was identified. Males were more commonly affected and were mostly in the age group of 31-40 yr. It was seen that trauma was the most common predisposing factor especially in the agriculturists and the farmers. Aspergillus flavus was the most common fungus isolated in 31.16 per cent cases, followed by A. fumigatus (16.88%) and Fusarium spp. (7.79%). Yeasts were also isolated in 21.62 per cent cases. Both yeasts and mycelial fungi were isolated in 6.5 per cent of cases. Interpretation & conclusion Because of serious consequences of infectious keratitis, it is important to know the exact aetiology of corneal ulcer to institute appropriate therapy in time. Laboratory confirmation should be undertaken and fungal infection should be ruled out before prescribing corticosteroids and antibacterial antibiotics.

Mycological profile of infectious Keratitis from Delhi.

Background & objective Epidemics of cholera caused by toxigenic Vibrio cholerae O1 and O139 (Bengal strain) represent a major public health problem in most developing countries. In view of the reported shift in epidemiology and pattern of antibiotic resistance in this was study carried out to assess the development of resistance to essential drugs like fluoroquinolones during treatment of cholera and cholera like cases in Delhi. Methods Faecal specimens collected from 1184 patients with cholera and cholera like illness between 2001-2006 admitted to Guru Teg Bahadur hospital, East Delhi were subjected to culture isolation. Antimicrobial susceptibility testing of V. cholerae isolates was done by disc diffusion method. Results Of the 1184 faecal samples examined, 670 (56.6%) were positive for V. cholera from 2001- 2006. V. cholerae El Tor Ogawa (54.6%) was more common than serotype Inaba (32.5%). During 2004-2006 V. cholerae Inaba emerged as the predominant serotype. Resistance to nalidixic acid, furazolidone and co-trimoxazole was constantly high (100%). Multiple antibiotic resistance (MAR) V. cholerae O1 Inaba isolates exhibited increased resistance to ciprofloxacin with MIC >4 microg/ml, but largely all remained susceptible to other antibiotics like, gentamicin, tetracycline and chloramphenicol. Interpretation & conclusion V. cholerae have a permanent existence in the environment and during the quiescent period, their survival in water bodies allows dissipation of resistance patterns to different serotypes or strains of V. cholerae O1 and therefore there is need for constant observation.

Trend of antibiotic resistance of Vibrio cholerae strains from East Delhi.

Rhinosporidiosis is a disease caused by Rhinosporidium seeberi which primarily affects the mucosa of the nose, conjunctiva and urethra. While it is endemic in some Asian regions, isolated cases are reported in other parts of the world as a result of the socio-cultural phenomenon of the migration. Its manifestation is a polypoid mass growing inside the affected cavity and the only treatment is surgical excision. Rhinosporidiosis is a condition which both clinicians and microbiologists should keep in mind when managing patients with nasal masses even those from non endemic areas. It is critical in such cases to follow the clinical course to ensure against recurrence of the disease. This study describes the clinical features, diagnosis, and treatment of rhinosporidiosis of the nose and nasopharynx in a series of three cases in East Delhi, India.

/pdf/nasal-rhinosporidiosis-in-humans-new-interpretations-and-a-3dm3nj8nga.pdf

Nasal rhinosporidiosis in humans: new interpretations and a review of the literature of this enigmatic disease

Introduction: Considering the changing geographical and temporal occurrence of Vibrio cholerae, there is a continuing need to monitor the strain characteristics and antibiotic resistance patterns of this pathogen. The present study was conducted to document the changing biology of V. cholerae isolates in and around Delhi, India, and the development of antibiotic resistance. Methodology: A total of 1,424 stool samples or rectal swabs from patients with acute secretory diarrhoea admitted to Guru Teg Bahadur Hospital, Delhi, between January 2007 and December 2009 were processed using standard bacteriological methods. Strains identified as V. cholerae were further subjected to serogrouping, phage typing and antimicrobial susceptibility testing. Minimum inhibitory concentration (MIC) of gentamicin and tetracycline was determined. Results: V. cholerae was isolated in 242/1,424 (17.0%) specimens. Of these, the majority were V. cholerae O1 serotype (98.3%) and serovar Ogawa. The drugs to which V. cholerae O1 isolates showed high levels of resistance were nalidixic acid, furazolidone, and cotrimoxazole throughout the study period, whereas strains were usually susceptible to chloramphenicol and cefotaxime. In 2007, there was a sudden increase of resistance to gentamicin and tetracycline, followed by a slow reversal to previous levels in subsequent years. The phage typing pattern (Basu and Mukherjee scheme) showed a dominance of phage type 2 throughout the study period. Conclusion: The importance of reporting all cases of V. cholerae , should be greatly emphasized, with the ultimate goal of understanding the constantly changing resistance patterns of this pathogen .

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Rumpa Saha

Papers

Acremonium Species: A Review of the Etiological Agents of Emerging Hyalohyphomycosis

Mycological profile of infectious Keratitis from Delhi.

Trend of antibiotic resistance of Vibrio cholerae strains from East Delhi.

Nasal rhinosporidiosis in humans: new interpretations and a review of the literature of this enigmatic disease

Emergence of multiple drug resistance Vibrio cholerae O1 in East Delhi