Sporotrichosis is endemic in the Sub-Himalayan belt, which ranges from the northern to the north-eastern Indian subcontinent. Similar to many parts of the developing world, sporotrichosis is commonly recognized clinically in this region however consolidated epidemiological data is lacking. We report epidemiological, clinical and microbiological data from a hundred culture positive cases of sporotrichosis. Out of 305 clinically suspicious cases of sporotrichosis, a total of 100 isolates were identified as Sporothrix schenckii species complex ( S. schenckii ) on culture. Out of the culture proven cases 71% of the cases presented with lymphocutaneous type of lesions while 28% had fixed localized type and 1% had disseminated sporotrichosis. Presentation with lesions on hands was most frequently seen in 32% with arm (23%) and face (21%) in that sequence. The male to female ratio was 1∶1.27. Age ranged from 1 ½ years to 88 years. Mean age was 43.25 years. Disease was predominantly seen in the fourth to sixth decade of life with 58% cases between 31 and 60 years of age. Since the first report from the region there has been a steady rise in the number of cases of sporotrichosis. Seasonal trends reveal that most of the patients visited for consultation in the beginning of the year between March and April. This is the first study, from the most endemic region of the Sub-Himalayan belt, to delve into epidemiological and clinical details of such a large number of culture proven cases over a period of more than eighteen years which would help in the understanding of the local disease pattern of sporotrichosis.

Introduction:Hirsutism has a significant impact on the quality of life and serves as a marker of underlying hormonal and systemic conditions. The aim of this study was to study the clinical, biochemical characteristics of these patients and other associations.Materials and Methods:Fifty (n=50) consecutive newly diagnosed patients of hirsutism were assessed during a period from August 2009 to July 2010 using modified Ferriman Gallwey (mF-G) score.Results:Idiopathic hirsutism (IH) was found in 30 (60%) patients followed by polycystic ovarian syndrome (PCOS) in 19 (38%) patients. Other causes included late-onset classic adrenal hyperplasia in two (4%) and hypothyroidism in four (8%) patients. The mean age at presentation was 23.8±6.657 years. Total (T) and free testosterone (fT), 17-hydroxyprogesterone was significantly higher in PCOS than IH.Conclusion:The present data show IH as the commonest cause of hirsutism in our study population. Face, chest, and lower abdomen have a higher impact on the hirsutism score while upper back, abdomen, and lower back are rarely involved.

The positive rapid rK39 immunochromatographic dipstick test in 100% VL and 31.8% LCL patients, and 6.5% dogs suggests that both VL and LCL in this focus are apparently being caused by L. donovani-infantum and that reservoir infection is perhaps being chiefly maintained in asymptomatic dogs. However, it needs corroborative evidence in the form of in-vitro parasite cultivation and/or PCR studies for confirmation. A more elaborate study is recommended.

Nocardia spp are gram-positive, aerobic, acid-fast bacteria which exist as saprophytes in nature. Invasive disseminated infections are particularly common in immunocompromised or debilitated hosts. Superficial infections with Nocardia spp occur as a result of local trauma and contamination of the wound. Clinically, it presents as acute infection (abscesses or cellulitis), mycetoma, or sporotrichoid infection. Differential diagnosis includes eumycetoma, chromomycosis, blastomycosis, coccidioidomycosis, sporotrichosis, tuberculosis, botryomycosis, syphilis, yaws, and neoplasia. Its diagnosis is confirmed by demonstrating the causative organism in exudates (as granules), tissue specimens, or cultures. Early diagnosis will obviate need for drastic surgical measures as early institution of chemotherapy is effective in most patients. However, its diagnosis is often delayed due to diverse clinical presentations and for want of clinical suspicion, particularly in non-endemic areas. This paper presents 4 clinical forms of this not so uncommon disease, emphasizing the importance of high index of clinical suspicion, especially in non-endemic regions; and the significance of repeated examination of exudates for Nocardia granules for an early diagnosis.

Background: Androgenetic alopecia (AGA) is the most common cause of hair loss in men with limited treatment options. Platelet-rich plasma (PRP) therapy is one of the newer treatment options in the management of AGA which has shown promising results. Aims and Objectives: This study was aimed at comparing the clinical efficacy of PRP therapy with minoxidil therapy. Materials and Methods: In the study, patients were randomized into two groups – Group A (given PRP therapy) and Group B (given minoxidil therapy). Both groups were followed up over a period of 6 months, and final analysis was done with the help of global photography, hair pull test, standardized hair growth questionnaire, patient satisfaction score; in addition, a comparison of platelet counts in PRP was done, to know that if a clinical correlation exists between platelet concentration and clinical improvement. A total of 40 patients clinically diagnosed with AGA were enrolled in the study with 20 patients in each group. Four patients from Group A (PRP) and six patients from Group B (minoxidil) could not complete the treatment for 6 months and were eventually excluded. Results: At the end of 6 months, 30 patients were evaluated to compare the efficacy of intradermal PRP and topical minoxidil therapy. On global photography, Group A (PRP) was found to have a comparatively better outcome than Group B (minoxidil). In hair pull test, hair growth questionnaire, and patient satisfaction score, Group A was found to be better than Group B. Mean platelet count at baseline was 3.07 ± 0.5 lac/mm, 3 while platelet count in final PRP prepared was 12.4 ± 1.7 lac/mm, and patients with a higher platelet count in PRP had a much better clinical improvement compared to patients with a low platelet count in PRP. Side effects with PRP therapy were minimal with better results which may improve the compliance of the patient. Conclusion: PRP therapy can be a valuable alternative to topical minoxidil therapy in the treatment of AGA.

L eishmaniasis is a complex disease with cutaneous, mucocutaneous, or visceral manifestations depending on the parasite species and host immunity. Despite continued elimination efforts, leishmaniasis continues to afflict known and newer endemic regions, where 0.5-0.9 million new cases of visceral leishmaniasis (VL) and 0.6-1.0 million new cases of cutaneous leishmaniasis (CL) occur every year (1). An increase in VL and CL cases from newer foci and atypical disease manifestation pose a challenge to leishmaniasis control programs (2-7). Unlike the known species-specific disease phenotype, parasite variants can cause atypical disease, so that Leishmania species generally associated with VL can cause CL and vice versa. In India, VL caused by L. donovani parasites in the northeastern region and CL caused by L. tropica in the western Thar Desert represent the prevalent forms of the disease (2). Himachal Pradesh is a more recently leishmaniasis-endemic state in northwest where VL and CL coexist; CL incidence is higher than VL incidence and most cases are attributable to L. donovani instead of L. tropica infection (8,9). Sharma et al. conducted limited molecular analysis of a few CL cases and reported preliminary findings (8). For an in-depth study on the involvement of L. donovani parasites in CL cases, we conducted a comprehensive molecular analysis of CL cases in Himachal Pradesh. The Study During 2014-2018, an increase in CL cases occurred in Himachal Pradesh; case reports came from different tehsils (i.e., townships) in Kinnaur, Shimla, and Kullu and the previously nonendemic districts of Mandi and Solan (Appendix Table 1, Figure 1, https://wwwnc.cdc.gov/EID/article/26/8/19-1761-App1.pdf). We confirmed 60 CL cases indigenous to the state with detailed patient information, demonstration of the presence of Leishman-Donovan bodies and CL-specific histopathologic changes in skin lesional specimens, and PCR detection of parasitic infection (Appendix). We conducted PCR and restriction fragmentlength polymorphism (RFLP) analysis of parasite species-specific internal transcribed spacer 1 (ITS1) sequences by using appropriate standard controls. We detected the expected ≈320-bp product with a HaeIII RFLP pattern specific to L. donovani complex in all patient biopsy specimens, indicating L. donovani, L. infantum, or both as the causative agent of infection (Appendix Figure 4) (10). BLAST analysis (https://blast.ncbi.nlm.nih. gov/Blast.cgi) of 44 ITS1 test sequences showed all the samples to be closest to L. donovani, having maximum identity to L. donovani isolates from Bhutan (GenBank accession nos. JQ730001-2) and possibly L. infantum. None of the CL cases were consistent with L. tropica infection, unlike in a previous report (8). To distinguish whether HP isolates were L. donovani, L. infantum, or both and to infer genetic and geographic relatedness between

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These 30 patients (M : F 21 : 9) were between 22-81 years of age having dermatitis for 4 days to 20 years with relapses and remissions. 21 patients had seasonal exacerbation. 10 patients attributed exacerbation of dermatitis to exposure to pesticides. Positive patch test reactions from pesticides were observed in 8 patients only. Captan was the most common sensitizer (5 patients), 2 patients were sensitive to propargite. Chlorpyrifos, tree spray oil and thiuram gave positive reaction in 1 patient each. 3 controls from Group-1 showed positive reactions to multiple pesticides. Pesticide related contact dermatitis appears more common than expected.