Mendelian Susceptibility to Mycobacterial diseases (MSMD) are a group of innate immune defects with more than 17 genes and 32 clinical phenotypes identified. Defects in the IFN-γ mediated immunity lead to an increased susceptibility to intracellular pathogens like mycobacteria including attenuated Mycobacterium bovis-Bacillus Calmette-Guérin (BCG) vaccine strains and non-tuberculous environmental mycobacteria (NTM), Salmonella, fungi, parasites like Leishmania and some viruses, in otherwise healthy individuals. Mutations in the IL12RB1 gene are the commonest genetic defects identified. This retrospective study reports the clinical, immunological, and molecular characteristics of a cohort of 55 MSMD patients from 10 centers across India. Mycobacterial infection was confirmed by GeneXpert, Histopathology, and acid fast bacilli staining. Immunological workup included lymphocyte subset analysis, Nitro blue tetrazolium (NBT) test, immunoglobulin levels, and flow-cytometric evaluation of the IFN-γ mediated immunity. Genetic analysis was done by next generation sequencing (NGS). Disseminated BCG-osis was the commonest presenting manifestation (82%) with a median age of presentation of 6 months due to the practice of BCG vaccination at birth. This was followed by infection with Salmonella and non-typhi Salmonella (13%), Cytomegalovirus (CMV) (11%), Candida (7%), NTM (4%), and Histoplasma (2%). Thirty-six percent of patients in cohort were infected by more than one organism. This study is the largest cohort of MSMD patients reported from India to the best of our knowledge and we highlight the importance of work up for IL-12/IL-23/ISG15/IFN-γ circuit in all patients with BCG-osis and suspected MSMD irrespective of age.

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The study was conducted in seven private coeducational English-medium schools in Cochin to understand adolescent attitudes in this part of the country. Queries submitted by students (n=10,660) and responses to separate pretested questionnaires for boys (n=886 received) and girls (n=589 received) were analysed. The study showed a lacuna of knowledge among adolescents with the most frequently asked queries being on masturbation, and sex and sexuality. More than 50% of adolescents received information on sex and sexuality from peers; boys had started masturbating by 12 yr age and 93% were doing so by 15 yr age. Although 73% of girls were told about menstruation by their parents, 32% were not aware, at menarche, that such an event would occur and only 8% were aware of all aspects of maintaining menstrual hygiene. 19% of boys succumbed to peer pressure into reading/viewing pornography; more than 50% of adolescents admitted to having had an infatuation around 13 yrs of age or after. 13% of boys admitted to having been initiated into smoking by friends; mostly between 14-16 yrs age; 6.5% boys had consumed alcohol with peers or at family functions, starting between ages of 15 to 17 yrs. Though >70% of adolescents were aware about AIDS, adequate knowledge about its spread and prevention was lacking.

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The aetiology of acute diarrhoea was investigated in 245 children less than 3 years old in a paediatric outpatient clinic in southern India. In 55% of the children organisms were found in the stools, and one quarter were infected with multiple organisms. Viruses, enteropathogenic E. coli, shigella and campylobacter species accounted for 75% of all isolates. Cholera and helminthiasis were rare, and no child had amoebiasis. Clinical findings were useful in the diagnosis of shigella and rotavirus infection only. Children with shigellosis had classical dysentery, and a greater number of stools; they were unlikely to be breast-fed, to be less than 6 months old, or to have watery stools. Rotavirus infections were characterized by vomiting. Only 20% of the 245 children had an infection which could be treated effectively with antimicrobials.

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CORRESPONDENCE include increased melanin synthesis (secondary to cytotoxic effect on melanocytes), cutaneous drug accumulation or iron deposits following dermal vascular damage, and increased blood flow to acral areas causes drug deposition [4,5].