Udhayasankar Ranganathan

Abstract

Background: Anti-nuclear antibodies (ANA) are known to be associated with autoimmune diseases and most commonly with connective tissue diseases (CTD). Screening for ANA is the first investigation of choice in the diagnosis of autoimmune diseases and indirect immunofluorescence (IIF) test using Hep-2 cells has been considered the gold standard method. The prevalence of autoimmune diseases and hence the ANA positivity and ANA IIF patterns differ in various geographical regions. Aims and Objectives: This study was aimed to estimate the ANA positivity rates among patients with suspected or confirmed auto immune diseases and to determine the common ANA IIF patterns in the positive samples. Materials and Methods: This is a retrospective study including 235 patients with either clinical suspicion of, or suffering from autoimmune diseases attending a tertiary health care hospital in Puducherry, South India, between November 2018 and April 2020. ANA IIF test (Hep 20-10/ primate liver, Euroimmun, Germany) was performed with 1:100 dilutions of patient serum. Results: The ANA positivity rate was 14.5% (34 out of 235 samples were positive). ANA was positive in 10 (13.3%) males and 24 (15%) females. The mean age of ANA positive patients were 43.4 years.The most common pattern was nucleus fine granular (n=8) followed by cytoplasm fine granular (n=7) and centromere (n=4). Conclusion: A significant ANA positivity rate was found in our study and a detailed clinical study has to be conducted to draw further conclusions. Keywords: Antinuclear antibodies, Indirect immunofluorescence test, ANA patterns.

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Abstract

Introduction: Urinary tract infection (UTI) is a common health problem across the globe. Although majority of them are bacterial in origin, there has been an increasing trend in the incidence of UTI due to the yeast like fungi, Candida. UTI due to Candida species are in large proportion noscomially acquired and of growing concern is the development of resistance to the commonly used azole group of drugs for their treatment. Since the resistance is more commonly reported among non- albicans Candida species, routine species identification and antifungal susceptibility testing is crucial for successful clinical outcomes. Aims and Objectives: This study was conducted to analyse the distribution and risk factors associated with Urinary candidiasis and also to determine the resistance patterns of different Candida species to various antifungal agents using phenotypic methods. Materials and Methods: A hospital based observational study was conducted from September 2016 to December 2017 on patients presenting with symptomatic UTI. Candida isolates were speciated using phenotypic methods like germ tube test and growth character on chromagar candida. Antifungal susceptibility to fluconazole, voriconazole, ketoconazole and amphotericin B were determined using disc diffusion method. Statistical Analysis: All data were anlyzed using EpiData Analysis software version 2.2.2.186. Results: A total of 101 Candida species were isolated. The incidence of Urinary candidiasis was more among females (66.4%) than in males (33.6%). People above 50 years (38.6%) were commonly affected followed by people in the age group of 21-30 years (22.7%). The incidence among hospitalized patients was 86.7% and urinary catheterization (43.5%) was the most commonly associated risk factor. The most common isolates were Candida tropicalis (31.6%) followed by Candida albicans (21.7%). The overall resistance patterns among various Candida species were 50.5%, 32.7%, 19.9% and 2% for fluconazole, ketoconazole, voriconazole and amphotericin B respectively. Conclusion: Hospitalization and urinary catheterization are the important risk factors for developing urinary candidiasis. The antifungal susceptibility varies among different Candida species and hence, identification of Candida to species level along with antifungal susceptibility testing should be practiced as a routine in all clinical mycology laboratories. Keywords: Urinary tract infection, Risk factors for urinary candidiasis, Candida species, Antifungal susceptibility.

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