Correspondence www.ijmm.org 463 July-September 2015 Table 1: Positive predictive value of different diagnostic methods in suspected fungal keratitis Diagnostic test Positive Negative Positive predictive value* Gram’s stain 26 89 22.6% 10% KOH wet mount 56 59 48.7% CFW+10% KOH wet mount 114 1 99.1% Culture 73 42 61.35 *Calculations based on composite gold standard, i.e., n=115. KOH: Potassium hydroxide, CFW: Calcofuor white fuorescent staining Access this article online Quick Response Code: Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.158609 Hyaline fungi, with Aspergillus spp from northern and eastern India and Fusarium spp. from south India, have been reported as the commonest cause of fungal keratitis. [2-5] As emphasized previously, though culture is the most defnitive method and direct visualization by KOH is most frequently used, a large number of cases that are missed can be easily detected by CFW stain with 10% KOH. References 1. Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: A global perspective. Bull World Health Organ 2001;79:214-21. 2. Sherwal BL, Verma AK. Epidemiology of ocular infection due to bacteria and fungus- A prospective study. JK Science 2008;10:127-31. 3. Chander J, Singla N, Agnihotri N, Arya SK, Deep A. Keratomycosis in and around Chandigarh: A fve‑year study from a north Indian tertiary care hospital. Indian J Pathol Microbiol 2008;51:304-6. 4. Rautaraya B, Sharma S, Kar S, Das S, Sahu SK. Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India. BMC Ophthalmol 2011;11:39. 5. Leck AK, Thomas PA, Hagan M, Kaliamurthy J, Ackuaku E, John M, et al. Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis. Br J Ophthalmol 2002;86:1211-15. MK Gupta, A Chandra, P Prakash, T Banerjee, OPS Maurya, *R Tilak Department of Microbiology (MKG, PP, TB, RT), Department of Ophthalmology (AC, OPSM), Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India *Corresponding author (email: <raginijain29@rediffmail.com>) Received: 23-05-2014 Accepted: 21-06-2014 The CSF specimen tested by polymerase chain reaction to amplify a 345 base pair region on the P1 adhesin gene of M. pneumoniae was negative. The serum was positive by ELISA (Calbiotech, CA, USA) for IgM antibodies to M. pneumoniae and by M. pneumoniae Serodia Myco II gelatin particle agglutination test (Fujirebio, Japan). The child was managed with mannitol, ceftazidime, azithromycin and amikacin. Two weeks after admission, the patient was discharged from the hospital. M. pneumoniae is responsible for at least 6.9% of cases of acute childhood encephalitis. [3] A study reported CNS manifestations associated with serologic evidence of acute infection with M. pneumoniae. [4] Several potential mechanisms include direct invasion of the CNS, immune complex formation, vascular injury, hypercoagulable state and toxic effects. [5] We suggest that M. pneumoniae should be considered as a potential cause of encephalitis in children. Serologic testing is more reliable for the diagnosis Dear Editor, Mycoplasma pneumoniae (M. pneumoniae) causes 6–20% of the community-acquired lower respiratory tract infections in older children and adults. [1] One of the most common extrapulmonary manifestations is central nervous system (CNS) complications with encephalitis as the most common pediatric manifestations. [2] We report M. pneumoniae infection in an 11-year-old boy presented with fever, accompanied by bifrontal headache and nonprojectile, nonbilious vomiting for the last 12 days. A diagnostic lumbar puncture revealed colourless CSF, pleocytosis with total lymphocyte count of 27 cells/mm 3 (polymorphs 6% and lymphocytes 94%). The CSF sugar was within normal limits (50–80 mg/dl) and proteins (normal range 15–45 mg/dl) were raised. No organisms were seen on direct microscopy or culture. Magnetic resonance imaging (MRI) scan of the brain was suggestive of hemorrhagic encephalitis. Hemorrhagic encephalitis caused by Mycoplasma pneumoniae in an 11-year-old boy: A rare case report [Downloaded free from http://www.ijmm.org on Saturday, June 13, 2015, IP: 61.16.135.116]