Biomedical subjects
Publications and source records attributed to A Kamalam.
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.
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Trichophyton simii produced kerion on the intact forearm skin due to a laboratory accident within 5 days of contact. Early institution of griseofulvin resolved the condition in 15 days with no recurrence during 38 months of follow-up.
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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.
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.
A case with encapsulated Tricophyton violaceum abscesses in the skin is recorded. Defective cell mediated immunity was shown in the patient and his two cousins. This defect combined with malnutrition, hypoadrenalism and griseofulvin resistance gave unusual lesions and chronicity. A probable genetic factor for the defective cell mediated immunity is postulated.
Cryptococcus laurentii was isolated twice from cutaneous granulomas in the leg and foot of a 40-year-old man. Histologically the cells of C. laurentii were found in groups in the dermis and also inside giant cells. There was epithelioid cell infiltration in the dermis and subcutis. An atypical mycobacterium was isolated in addition to C. laurentii. Therapy with anti-tuberculous drugs after an initial amphotericin B infusion was found to be satisfactory.
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.
Trichophyton violaceum infection was found in 26% of 69 children attending a public boarding school. The possible source of infection may have been the adult women from the gypsy community discussed. Treatment with systemic griseofulvin and external sulphur salicylic ointment eliminated the infection in all affected individuals.
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.
Two cases of Basidiobolomycosis caused by species of the order Entomophthorales are discussed with the report on lymph node involvement by B. haptosphorus. A clearer aetiological classification of the diseases caused by various agents belonging to the class Phycomycetes is preferred in view of the distinct clinical entities produced by them. Involvement of the lymph nodes is also an evidence that the disease produced by B. haptosporus is not restricted to subcutaneous tissue. A routine lymph node biopsy with mycological studies of the node is suggested in such cases.
A case of tylosis following corrosive stricture of the oesophagus in a male of 26 years is recorded. It is suggested that there is probably a connection between the state of the oesophagus and the state of palms and soles and that an oesophageal abnormality may precede tylosis of the late onset type.