143 Indian Journal of Medical Microbiology Vol.23, No.2 conditions (e.g., lupus and increased age) lead to antilipoidal disease control programme and acceptability to patients and antibodies and false positive results,2 hence a rapid, effective, health care providers will improve the diagnosis of syphilis practical confirmatory test is often required for diagnosis and in primary health care settings in developing countries and treatment. Syphicheck is a one step rapid self performing test reduce over treatment. which can qualitatively detect presence of IgG and IgM class of treponema specific antibodies in serum or plasma within References 15 minutes. It uses the principle of immunochromatography, a unique two site immunoassay on membrane. Positive results 1. Garner MF, Blackhouse JL, Daskalopoulos, et al. Treponema indicate a past or present infection, however a positive result pallidum Haemagglutination test for syphilis. Br J Vener Dis should always be evaluated in correlation with clinical 1972;48:470-3. condition before arriving at final diagnosis. Manufacturers 2. Young H. Syphilis, Serology. Dermatol Clin 1998;16:691-8. have reported 100% correlation between syphicheck and standard TPHA.3 Low levels of antibodies to Treponema 3. Syphicheck, One step test for syphilis (Dipstick) Data on File: pallidum at a very early primary stage of infection can give a Goa, India: Qualpro Diagnostics. negative result, nine such cases were detected in our study. However, Syphicheck in our study proved to be very helpful to exclude biological false positive results as well as to *N Goel, M Sharma, N Gupta, R Sehgal institute therapy in low titre (R1-R8) VDRL positive cases. Department of Microbiology, Pt. BD Sharma, Post As the results are available in 15 minutes and reproducible, Graduate Institute of Medical Sciences, it is better than standard TPHA which takes at least 3-4 hours. Rohtak - 124 001, Haryana, India Therefore, we conclude that syphicheck is a simple, rapid, point of care type treponema specific test suitable for use in *Corresponding author (email:
Coinfection of HSV with other Sexually Transmitted Diseases
Dear Editor,
The emerging prosodemic of AIDS/HIV disease in India yielding a subclinical HSV coinfection rate of 37.8%. Hence, has made STD Control as one of the strategies imperative and according to current WHO treatment regimen, 25 cases of probably the most important to decrease HIV transmission in primary/first episode genital HSV infections would have been community.1 Among various STDs, prevalence pattern of missed clinically leading to inappropriate treatment. This lapse syphilis and herpes genitalis is pivotal and NACO has already in diagnosis can nevertheless catapult onto grevious issued guidelines to test for these two diseases in AIDS as consequences like meningoencephalitis, disseminated herpes well as non-AIDS patients by serology. We conducted this or even death, especially if the patient becomes study to analyse the seroepidemiology of HSV in STD immunocompromised or if transmitted from mother to patients and to provide data for implementation of the joint newborn. STD/HIV control programme. In our study a large proportion (40.7%) of HSV positives Sera of 66 patients (22 females and 44 male) with various were females of child bearing age and can act as potential STD symptoms (21 ulcerative and 45 non-ulcerative) transmitters to their offspring. Transmission of infection from attending the STD clinic, JLN Hospital, Ajmer, was tested for HSV positive males to their sexual partners may further the presence of IgM antibodies to HSV-1 and 2 (to detect cascade the situation.3 Detection of subclinical HSV primary/first episode genital HSV infection)2 by ELISA, for coinfection by serology facilitates counselling regarding syphilis by RPR and TPHA and for HIV by ELISA. Out of advisability of acyclovir therapy (in addition to treating the 66 STD patients 27 were IgM-HSV positive (40.9%), 15 were other coexisting STD), the risk of recurrences and appropriate syphilis positive (22.7%) and 7 HIV positive (10.6%) (Table). measures to reduce HSV transmission to contacts.4 Coinfection rate of HSV in syphilis and HIV positives was 40.6% and 42.9% respectively. However only two out of the HIV infection in our STD clinic attendees was 10.6% 27 IgM-HSV positive patients had clinical herpes genitalis which is quite alarming. Our study strongly suggests that
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Table: Results of various tests in ulcerative and nonulcerative STDs
Type of STD Clinical diagnosis No. of IgM-HS RPR HIV cases positive positive positive Primary chancre 10 8 5 2 Ulcerative Chancroid 4 2 - - Herpes genitalis 4 2 1 2 Granuloma inguinale 3 1 - -
Secondary syphilis 9 6 7 1 Gonorrhoea 11 4 2 1 Non-Ulcerative Genital wart 10 2 - - Candidal balanoposthitis 5 1 - - Genital Molluscum contagiousum 8 1 - - Undiagnosed 2 - - 1 Total 66 27 15 7 % positive 40.9% 22.7% 10.6% every case of STD, be it ulcerative or non-ulcerative must be Bryson YJ. Ann Int Med 1993;118:414-8. thoroughly evaluated by laboratory testing for primary 4. Arvin AM, Prober CG. Herpes Simplex viruses: Manual of Clin subclinical genital HSV coinfection as this has profound Microbiol 1998. p. 878. implications on their judicious management and aversion of complications.5 5. Donahue DB. Diagnosis and Treatment of Herpes Simplex infection during pregnancy. JOGNN Clinical Issues 2002;31:99- References 106.
1. Merten TE, Smith GD, Kantharaj K, Mugritchian D, Radha- BP Peters, *VL Rastogi, Monica, PS Nirwan Krishnan KM. Observation of STD Consultations in India. Department of Microbiology, Public Health 1998;112:123-8. Jawaharlal Nehru Medical College and Hospital, Ajmer, Rajasthan - 305 001, India 2. HODWT, Field PR, Sjogren-Jansson E, Indirect ELISA for the detection of IgG and IgM antibodies with glycoprotein G (gG2) J Virol Methods 1992;36:249-64. *Corresponding author (email:
Prevalence of Non-Keratinophilic Fungi in the Soil
Dear Editor,
Majority of the fungi producing diseases in man and were obtained from sites of rat burrows at the bottom of animals exist freely in nature as soil saprophytes or plant bamboo trees, which is natural habitat around the place and pathogens and gain entrance into the body through abrasion, commonly seen surrounding Manipal. implantation or inhalation. Adametz isolated fungi for the first time from the soil in the year 1886, since then there has been About 10 grams of each sample of soil was transferred to very few reports.1-3 Manipal and surrounding places being a sterile tube containing 15-20 mL of sterile saline. The coastal areas, experience heavy rainfall with high atmospheric suspension was shaken vigorously and allowed to stand for humidity which is most suitable for fungal growth. Soil with 30 minutes. One mL of the clean supernatant fluid was natural bamboo habitat in nearby Western ghats with rat inoculated into two tubes of Sabouraud broth and for the 2 burrows predisposes the fungal growth in the area. isolation of Nocardia spp. by paraffin bait technique. Another 5 mL of the supernatant fluid was transferred to a sterile tube Soil samples collected in sterile paper envelops from 40 containing 5 mL of sterile saline with antibiotics (500 units different areas surrounding Manipal in the month of October of penicillin and 30 mg of streptomycin/mL), shaken well and (post monsoon) were investigated for the presence of fungi allowed to stand for two hours in order to reduce the bacterial as per the standard protocol described earlier.2 Soil samples flora. A portion of the suspension was inoculated on
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