oxyurea and was planned for allogeneic bone marrow transplantation. However before transplant she developed lymphoid blast crisis in October 1994. She was treated with Very few cases of human microsporidial infection have been reported. The advent of AIDS has changed this. a combination of l-asparaginase, vincristine, daunomycin and prednisolone. She also received intrathecal methotrex-There is increasing recognition that microsporidia are important opportunistic pathogens. However, the num-ate and cranial irradiation, following which her disease reverted to the chronic phase. ber of cases reported in the non-HIV population is small. We report here a case of microsporidial infection She underwent HLA-matched sibling (brother) allogeneic marrow transplant on 15 January 1995 after con-in a female patient with chronic myeloid leukemia undergoing allogeneic bone marrow transplantation. ditioning with BuCy 2. Cyclosporin A and short course methotrexate were given for GVHD prophylaxis. Granulo-There was also an associated fungal infection. The diagnosis could be reached only after postmortem and was cyte-monocyte colony-stimulating factor (GM-CSF) was used post-transplant (7.5 g/kg body weight) to hasten confirmed by electron micrography. We suggest that transplant patients are another group of patients who neutrophil recovery. Two days post-transplant she developed a fever up to are susceptible to this group of opportunistic pathogens. Keywords: microsporidia; opportunistic pathogen; mar-38.3°C and was started on broad spectrum antibiotics. On day + 5 two small maculopapular skin lesions were noted row transplant on the abdomen. On the sixth day post-transplant she vomited around 1.3 l and subsequently developed paralytic ileus. Plain X ray of the abdomen revealed multiple air Microsporidia are obligate intracellular protozoan parasites fluid levels and she was managed conservatively with nil which are known to cause human infection. 1 With the by mouth and continuous nasogastric tube aspiration. The advent of the acquired immunodeficiency syndrome patient had massive nasogastric fluid loss amounting to 3-(AIDS), microsporidia have been recognized as increas-4 l each day till day +9 which subsequently reduced so that ingly important opportunistic pathogens. Nine cases have by day +13 the tube could be removed. The nasogastric also been described in non-HIV-infected humans. 2 The tube aspirate did not grow any pathogens on culture. potential sources and means of transmission of human On day 8 post-transplant, the skin lesions progressed to microsporidial infection are uncertain. cover approximately 54% of body surface area and the We report here a case of microsporidiosis in a patient serum bilirubin was 92 mmol/l, in view of which a clinical with CML undergoing allogeneic marrow transplantation diagnosis of acute graft-versus-host disease (grade IV) was who had diarrhea, paralytic ileus, myopathy and respiratory made. She was started on methylprednisolone at a dose of symptoms. This diagnosis was be made only at postm...

To assess the effect of combination chemotherapy with doxorubicin, bleomycin, viablastine, and decarbazine (ABVD) on gonadal function in patients treated for Hodgkin's disease, we assessed 38 male patients with Hodgkin's disease who were > 15 years of age and in complete remission for the development of secondary sexual characteristics, sexual habits, and fatherhood after treatment. Semen analysis and serum hormone level estimation of follicle-stimulating hormone (FSH), leutinising hormone (LH), and testosterone (T) were done in all cases. Twenty-six patients received ABVD therapy and 12 received a combination of ABVD with COPP or MOPP (cyclophosphamide or nitrogen mustard, vincristine, procarbazine, and prednisone). Radiation of the pelvic region was done in one case. Median time between completion of therapy and assessment of gonadal function was 34 months (range, 12-68 months). Secondary sexual characteristics developed normally in all patients. Azoospermia was seen in one patient from the ABVD group and 10 patients from the COPP/ABVD group (p < 0.001). Serum FSH levels were significantly higher in the COPP/ABVD group than in the ABVD group (23.5 versus 4.7 mlu/ml; p < 0.001) The levels were in the normal range in 23 patients from the ABVD group, as compared to four in the COPP/ABVD group (88.5% versus 33.3%; p < 0.001). Three patients treated with ABVD fathered children post-therapy. We conclude that ABVD is associated with relatively better preservation of gonadal function.

Chikungunya fever is self-limiting. However, neurological and hemorrhagic complications have been seen in recent outbreaks. The clinical manifestations of this disease are similar to those of dengue virus infection, indicating the need for differential diagnosis in areas such as India, which are endemic for both viruses. The aim of the present study was to develop monoclonal antibodies (MAbs) against Chikungunya virus (CHIKV) and assess their use in MAb-based IgM capture ELISA (MAC ELISA). The ELISA detects CHIKV-specific IgM antibodies, a marker of recent infection, in a patient's serum. One IgG1 and two IgM isotype hybrids were obtained. All of the subclones derived from the IgG1 hybrid recognized the C protein of CHIKV. The anti-C MAb ClVE4/D9 was the most promising as a detector antibody in MAC ELISA (C-MAb ELISA) yielding higher positive-to-negative (P/N) ratios. When compared with the CHIKV MAC ELISA kit developed by the National Institute of Virology (NIV), Pune (NIV MAC ELISA), the sensitivity of the test was 87.01 % with 100 % specificity. The positive and negative predictive values (PPV and NPV) were 100 % and 94.47 %, respectively. In precision testing, standard deviation (SD) and coefficient of variation (% CV) values of the C-MAb ELISA were within acceptable limits. The C-MAb ELISA detected anti-CHIKV IgM in serum of patients up to five months after the onset of infection, indicating that anti-C MAbs have strong potential for use in MAC ELISA to detect recent CHIKV infection.

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