1
|
Manchanda V, Siddiqui O, Meena K, Sharma A, Saxena S. Quality assurance of SARS-CoV-2 testing laboratories during the pandemic period in India - An experience from a designated provider laboratory. Indian J Med Microbiol 2024; 49:100577. [PMID: 38588879 DOI: 10.1016/j.ijmmb.2024.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Indian Council of Medical Research (ICMR) initiated an Inter-Laboratory Quality Control testing (ILQC) program for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing. Under this program, SARS-CoV-2 testing laboratories across the country submit specimens to the assigned State Quality Control (SQCs) laboratories for ILQC testing. This study aimed to investigate the performance of public and private SARS-CoV-2 testing laboratories in Delhi and highlights the country's effort in ramping up testing facility with close monitoring of the quality of Covid-19 testing results. METHODS In the present study, two-years of SARS-CoV-2 testing data is included. During July 2020 through February 2022, a total of 1791 anonymised specimens were received from 56 public and private laboratories. These specimens were processed by reverse transcriptase - polymerase chain reaction (RT-PCR) tests as per National Institute of Virology (NIV) protocol and the results were uploaded on the ICMR quality control/quality assurance (QC/QA) portal without directly conveying the results to respective participating laboratories. This portal generated a final report stating concordance and intimate results to individual laboratories. RESULTS Among the 1791 specimens, 25 were rejected and the remaining 1766 were tested. Among these specimens 1691 (95.75%) revealed concordance, and 75 (4.24%) were discordant. A total of 29 laboratories had 100% concordance, 21 laboratories had over 90% concordance and six laboratories had over 80% concordance. CONCLUSIONS The study demonstrates that the establishment of an inter-laboratory comparison program for SARS-CoV-2 testing helped in monitoring quality of SARS-CoV-2 testing in the country.
Collapse
Affiliation(s)
- Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India; State Level -Viral Research and Diagnostic Laboratory (VRDL), Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Oves Siddiqui
- Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India; State Level -Viral Research and Diagnostic Laboratory (VRDL), Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Kavita Meena
- Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Anju Sharma
- State Level -Viral Research and Diagnostic Laboratory (VRDL), Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India; State Level -Viral Research and Diagnostic Laboratory (VRDL), Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| |
Collapse
|
2
|
Manchanda V, Muralidharan J, Nischal N, Aggarwal K, Gupta S, Gupta N, Velayudhan A, Kaur H, Brijwal M, Chhabra M, Vishwanathan R, Dhodapkar R, Mahajan SK, Deol S, Sekhar JC, Mitra S, Saxena S, Kumar J, Garg A, Lodha R, Ravi V, Soneja M, Verghese VP, Rodrigues C. Approach towards surveillance-based diagnosis of acute respiratory illness in India: Expert recommendations. Indian J Med Microbiol 2024; 48:100548. [PMID: 38403268 DOI: 10.1016/j.ijmmb.2024.100548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Emerging infectious diseases, often zoonotic, demand a collaborative "One-Health" surveillance approach due to human activities. The need for standardized diagnostic and surveillance algorithms is emphasized to address the difficulty in clinical differentiation and curb antimicrobial resistance. OBJECTIVE The present recommendations are comprehensive diagnostic and surveillance algorithm for ARIs, developed by the Indian Council of Medical Research (ICMR), which aims to enhance early detection and treatment with improved surveillance. This algorithm shall be serving as a blueprint for respiratory infections landscape in the country and early detection of surge of respiratory infections in the country. CONTENT The ICMR has risen up to the threat of emerging and re-emerging infections. Here, we seek to recommend a structured approach for diagnosing respiratory illnesses. The recommendations emphasize the significance of prioritizing respiratory pathogens based on factors such as the frequency of occurrence (seasonal or geographical), disease severity, ease of diagnosis and public health importance. The proposed surveillance-based diagnostic algorithm for ARI relies on a combination of gold-standard conventional methods, innovative serological and molecular techniques, as well as radiological approaches, which collectively contribute to the detection of various causative agents. The diagnostic part of the integrated algorithm can be dealt at the local microbiology laboratory of the healthcare facility with the few positive and negative specimens shipped to linked viral disease research laboratories (VRDLs) and other ICMR designated laboratories for genome characterisation, cluster identification and identification of novel agents.
Collapse
Affiliation(s)
- Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Jayshree Muralidharan
- Department of Pediatric Medicine (Advanced Pediatric Centre), PGIMER, Chandigarh, India.
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Kshitij Aggarwal
- Department of Pulmonary and Critical Care Medicine, Institute of Heart and Lung Diseases, Bahadurgarh, Haryana, India
| | - Swati Gupta
- Department of Radiodiagnosis, Maulana Azad Medical College, Delhi, India
| | - Nivedita Gupta
- Division of Epidemiology & Communicable Diseases, ICMR Headquarters, New Delhi, India
| | - Anoop Velayudhan
- Division of Epidemiology & Communicable Diseases, ICMR Headquarters, New Delhi, India
| | - Harmanmeet Kaur
- Division of Epidemiology & Communicable Diseases, ICMR Headquarters, New Delhi, India
| | - Megha Brijwal
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Mala Chhabra
- Department of Microbiology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital (RML), Delhi, India
| | | | | | - Sanjay K Mahajan
- Department of Medicine, Indira Gandhi Medical College & Hospital (IGMC), Shimla, India
| | - Saumya Deol
- Division of Epidemiology & Communicable Diseases, ICMR Headquarters, New Delhi, India
| | | | - Srestha Mitra
- Department of Microbiology, Maulana Azad Medical College, Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College, Delhi, India
| | - Jyoti Kumar
- Department of Radiodiagnosis, Maulana Azad Medical College, Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College, Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - V Ravi
- Department of Neurovirology, NIMHANS, Bengaluru, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | | | | |
Collapse
|
3
|
Khyati, Manchanda V, Pumma P, Chawla R, Garg S, Saxena S. Diagnostic performance of saliva RT-PCR test as a diagnostic tool and its utility in the detection of SARS-CoV-2 shedding with different patient characteristics: Prospective observational study. Indian J Med Microbiol 2024; 47:100490. [PMID: 37890412 DOI: 10.1016/j.ijmmb.2023.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Salivary shedding of SARS-CoV-2 is a known entity and its role has been established in transmission of the disease. The present study was performed to evaluate the duration of viral shedding in saliva in COVID-19 patients and its variation among symptomatic and asymptomatic patients with or without co-morbidities. METHODS The present prospective observational study was conducted at the COVID-19 care hospital associated with primary to tertiary care in New Delhi, India. A total of 124 COVID-19 confirmed cases enrolled in two phases (January-March 2021; April-June 2021) who consented for 48hrly saliva and nasopharyngeal swab (NPS) specimens till discharge from the hospital for SARS-CoV-2 detection were included. The specimens obtained were tested for SARS-CoV-2 by Real-Time PCR. RESULTS The sensitivity and the specificity of RT-PCR on saliva were 81.7 % and 85.0 %, respectively. The sensitivity of saliva-based PCR was comparable in symptomatic and asymptomatic patients (81.6 % vs 82.1 %). The sensitivity of saliva-based PCR markedly increased in the second phase of enrollment as compared to the first phase (92.6 % vs 78.5 %) indicating higher level of salivary shedding by the delta variant of SARS-CoV-2. The sensitivity of PCR on saliva was the highest up to day seven of illness. The median duration of RNA shedding in saliva was comparable among the symptomatic and asymptomatic patients. The severity of the disease was not associated with the duration of SARS-CoV-2 shedding in saliva. CONCLUSIONS SARS-CoV-2 shedding in saliva continued till seven days in large number of patients including asymptomatic patients. Saliva is non-inferior to NPS specimen in the diagnosis of SARS-CoV-2. Saliva specimen is recommended as a good alternate to NPS for SARS-CoV-2 testing.
Collapse
Affiliation(s)
- Khyati
- Department of Microbiology, Maulana Azad Medical College, 110002, New Delhi, India
| | - V Manchanda
- Department of Microbiology, Maulana Azad Medical College, 110002, New Delhi, India.
| | - P Pumma
- Department of Microbiology, Maulana Azad Medical College, 110002, New Delhi, India
| | - R Chawla
- Department of Microbiology, Maulana Azad Medical College, 110002, New Delhi, India
| | - S Garg
- Department of Medicine, Maulana Azad Medical College, 110002, New Delhi, India
| | - S Saxena
- Department of Microbiology, Maulana Azad Medical College, 110002, New Delhi, India
| |
Collapse
|
4
|
Sharma A, Manchanda V, Agarwal A, Kapoor A, Kumar S, Saxena S. Blood borne infections and Hepatitis B virus immunization levels among medical students in India. Indian J Med Microbiol 2024; 47:100525. [PMID: 38160719 DOI: 10.1016/j.ijmmb.2023.100525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Medical students are actively involved in direct patient care during their training and subsequent medical practice, making them susceptible to acquiring blood-borne pathogens, including HBV. This study aimed to assess the occurrence of blood-borne infections and the Hepatitis B immunization status among medical students. Furthermore, it sought to identify gaps in risk assessment for blood-borne pathogens among medical students at a Medical College in New Delhi. METHODS The study included 108 medical students who participated in a blood donation camp. Blood samples collected from these individuals underwent testing for blood-borne pathogens in accordance with standard screening protocols at the blood bank. The quantitative estimation was performed for anti-HBs IgG using ELISA. RESULTS All 108 participants were pursuing their undergraduate or postgraduate medical degrees. All students tested negative for HBsAg and HIV markers and showed no reactivity to Syphilis and Malaria. However, one student tested positive for HCV. Two postgraduate students had a history of needlestick injuries. Eighty-one (75%) students had received Hepatitis B vaccination. Among the vaccinated students, 34 (41.97%) were immunized before the age of five years, 22 (27.16%) after the age of five years, while 25 (30.86%) couldn't recall the exact age of their Hepatitis B vaccination. Protective anti-HBs titer of anti-Hepatitis B antibodies (>10 mIU/ml) were detected in 48.15% (52/108) of students. CONCLUSIONS Over 50% of medical students did not possess sufficient immunity against HBV infection, putting them at a heightened risk of acquiring HBV during their active participation in patient care in the near future. It is imperative to establish a policy for routine anti-HBs titer assessment and ensure easy access to Hepatitis B immunization for medical students, thereby enhancing their protection against this infectious agent.
Collapse
Affiliation(s)
- Anju Sharma
- State Level -Viral Research and Diagnostic Laboratory (VRDL), Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Vikas Manchanda
- State Level -Viral Research and Diagnostic Laboratory (VRDL), Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Aman Agarwal
- Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Advitiya Kapoor
- Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Sunil Kumar
- Blood Bank, Lok Nayak Hospital, New Delhi, India.
| | - Sonal Saxena
- State Level -Viral Research and Diagnostic Laboratory (VRDL), Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| |
Collapse
|
5
|
Nathani M, Singh V, Sharma A, Manchanda V, Saxena S, Juneja M. Autoimmune encephalitis: A diagnostic enigma. Indian J Med Microbiol 2023; 46:100477. [PMID: 37742479 DOI: 10.1016/j.ijmmb.2023.100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Abstract
Autoimmune encephalitis with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis is the most common type. This condition can be associated with underlying malignancy, making appropriate screening essential. Prompt identification and intervention of autoimmune encephalitis is essential for a successful outcome and full recovery from this serious and potentially fatal condition. Immunotherapy is typically used to suppress the immune response and reduce brain inflammation. The choice of therapy depends on the type and severity of autoimmune encephalitis, as well as the presence of an underlying tumour.
Collapse
Affiliation(s)
| | | | - Anju Sharma
- Maulana Azad Medical College, New Delhi, India.
| | | | | | | |
Collapse
|
6
|
Sartelli M, Barie PS, Coccolini F, Abbas M, Abbo LM, Abdukhalilova GK, Abraham Y, Abubakar S, Abu-Zidan FM, Adebisi YA, Adamou H, Afandiyeva G, Agastra E, Alfouzan WA, Al-Hasan MN, Ali S, Ali SM, Allaw F, Allwell-Brown G, Amir A, Amponsah OKO, Al Omari A, Ansaloni L, Ansari S, Arauz AB, Augustin G, Awazi B, Azfar M, Bah MSB, Bala M, Banagala ASK, Baral S, Bassetti M, Bavestrello L, Beilman G, Bekele K, Benboubker M, Beović B, Bergamasco MD, Bertagnolio S, Biffl WL, Blot S, Boermeester MA, Bonomo RA, Brink A, Brusaferro S, Butemba J, Caínzos MA, Camacho-Ortiz A, Canton R, Cascio A, Cassini A, Cástro-Sanchez E, Catarci M, Catena R, Chamani-Tabriz L, Chandy SJ, Charani E, Cheadle WG, Chebet D, Chikowe I, Chiara F, Cheng VCC, Chioti A, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Dasic M, de Francisco Serpa N, de Jonge SW, Delibegovic S, Dellinger EP, Demetrashvili Z, De Palma A, De Silva D, De Simone B, De Waele J, Dhingra S, Diaz JJ, Dima C, Dirani N, Dodoo CC, Dorj G, Duane TM, Eckmann C, Egyir B, Elmangory MM, Enani MA, Ergonul O, Escalera-Antezana JP, Escandon K, Ettu AWOO, Fadare JO, Fantoni M, Farahbakhsh M, Faro MP, Ferreres A, Flocco G, Foianini E, Fry DE, Garcia AF, Gerardi C, Ghannam W, Giamarellou H, Glushkova N, Gkiokas G, Goff DA, Gomi H, Gottfredsson M, Griffiths EA, Guerra Gronerth RI, Guirao X, Gupta YK, Halle-Ekane G, Hansen S, Haque M, Hardcastle TC, Hayman DTS, Hecker A, Hell M, Ho VP, Hodonou AM, Isik A, Islam S, Itani KMF, Jaidane N, Jammer I, Jenkins DR, Kamara IF, Kanj SS, Jumbam D, Keikha M, Khanna AK, Khanna S, Kapoor G, Kapoor G, Kariuki S, Khamis F, Khokha V, Kiggundu R, Kiguba R, Kim HB, Kim PK, Kirkpatrick AW, Kluger Y, Ko WC, Kok KYY, Kotecha V, Kouma I, Kovacevic B, Krasniqi J, Krutova M, Kryvoruchko I, Kullar R, Labi KA, Labricciosa FM, Lakoh S, Lakatos B, Lansang MAD, Laxminarayan R, Lee YR, Leone M, Leppaniemi A, Hara GL, Litvin A, Lohsiriwat V, Machain GM, Mahomoodally F, Maier RV, Majumder MAA, Malama S, Manasa J, Manchanda V, Manzano-Nunez R, Martínez-Martínez L, Martin-Loeches I, Marwah S, Maseda E, Mathewos M, Maves RC, McNamara D, Memish Z, Mertz D, Mishra SK, Montravers P, Moro ML, Mossialos E, Motta F, Mudenda S, Mugabi P, Mugisha MJM, Mylonakis E, Napolitano LM, Nathwani D, Nkamba L, Nsutebu EF, O’Connor DB, Ogunsola S, Jensen PØ, Ordoñez JM, Ordoñez CA, Ottolino P, Ouedraogo AS, Paiva JA, Palmieri M, Pan A, Pant N, Panyko A, Paolillo C, Patel J, Pea F, Petrone P, Petrosillo N, Pintar T, Plaudis H, Podda M, Ponce-de-Leon A, Powell SL, Puello-Guerrero A, Pulcini C, Rasa K, Regimbeau JM, Rello J, Retamozo-Palacios MR, Reynolds-Campbell G, Ribeiro J, Rickard J, Rocha-Pereira N, Rosenthal VD, Rossolini GM, Rwegerera GM, Rwigamba M, Sabbatucci M, Saladžinskas Ž, Salama RE, Sali T, Salile SS, Sall I, Kafil HS, Sakakushev BE, Sawyer RG, Scatizzi M, Seni J, Septimus EJ, Sganga G, Shabanzadeh DM, Shelat VG, Shibabaw A, Somville F, Souf S, Stefani S, Tacconelli E, Tan BK, Tattevin P, Rodriguez-Taveras C, Telles JP, Téllez-Almenares O, Tessier J, Thang NT, Timmermann C, Timsit JF, Tochie JN, Tolonen M, Trueba G, Tsioutis C, Tumietto F, Tuon FF, Ulrych J, Uranues S, van Dongen M, van Goor H, Velmahos GC, Vereczkei A, Viaggi B, Viale P, Vila J, Voss A, Vraneš J, Watkins RR, Wanjiru-Korir N, Waworuntu O, Wechsler-Fördös A, Yadgarova K, Yahaya M, Yahya AI, Xiao Y, Zakaria AD, Zakrison TL, Zamora Mesia V, Siquini W, Darzi A, Pagani L, Catena F. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg 2023; 18:50. [PMID: 37845673 PMCID: PMC10580644 DOI: 10.1186/s13017-023-00518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
Collapse
|
7
|
Manchanda V, Mitra S, Rafique I, Sharma A, Dhakad MS, Saxena S, Kapoor S, Kumar S. Is Omicron really mild? - Comparative analysis of comorbidities and disease outcomes associated with SARS-CoV-2 Omicron (B.1.1.529) and Delta (B.1.617.2) variants. Indian J Med Microbiol 2023; 45:100391. [PMID: 37573055 PMCID: PMC10242243 DOI: 10.1016/j.ijmmb.2023.100391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/10/2023] [Accepted: 05/21/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Multiple variants of SARS-CoV-2 from Alpha to Omicron have an estimated 6.1 million deaths globally till date. These variants have been found to vary in transmissibility and severity. The present study deals with comparison of morbidity and mortality with SARS-CoV-2 Omicron (B.1.1.529) and Delta (B.1.617.2) variants. MATERIALS AND METHOD An observational retrospective cohort study was conducted on a cohort of laboratory confirmed patients of SARS-CoV-2 diagnosed by qRT-PCR of nasopharyngeal swabs in periods; April-2021 and January-2022; that were sequenced and variants were recorded. Patients were invited for a telephonic interview after voluntary and informed consent was obtained from each participant wherein, the demographics, co-morbidities, oxygen requirement and mortality outcomes of the patients were enquired about. RESULTS A total of 200 patients, with 100 from each period were included in the study. Major comorbidities in patients included hypertension, diabetes mellitus and pulmonary disease. Patients who succumbed to the Delta variant (26%) were higher as compared to the Omicron variant (10%); with the elderly (68 ± 9.7 years) having significant mortality during the Omicron variant. The mortality was increased in patients with comorbidities as with hypertension (53.8%, 70%), diabetes mellitus (26.9%, 40%), chronic pulmonary disease (30.8%, 20%), and smoking (15.4%, 40%) in the patients infected with both Delta and Omicron variants, respectively. CONCLUSION The study concluded that the newer strains of SARS-CoV-2 have potential of high transmissibility and milder disease for the population by large, however, for patients with comorbidities have a higher proportion of adverse outcomes, irrespective of the variant.
Collapse
Affiliation(s)
- Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Srestha Mitra
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Iram Rafique
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Anju Sharma
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Megh Singh Dhakad
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India.
| | - Seema Kapoor
- Department of Pediatrics, Pediatric Research and Genetic Lab, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India.
| | - Suresh Kumar
- Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India.
| |
Collapse
|
8
|
Jain A, Jain K, Jhurani D, Mishra A, Mohapatra S, Sharma A, Manchanda V, Sankar MJ, Agarwal R. Umbilical Cord Blood IgA Levels and Bacterial Profile in Preterm Neonates Born with Maternal Risk Factors for Early-Onset Neonatal Sepsis. Indian J Pediatr 2023:10.1007/s12098-023-04708-4. [PMID: 37523074 DOI: 10.1007/s12098-023-04708-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To investigate the IgA levels and bacterial profile in umbilical cord blood (UCB) samples of mothers with risk factors compared to those without risk factors; and to understand the link between UCB culture positivity and neonatal outcomes [early-onset sepsis (EOS) or death within 7 d of life]. METHODS This is a pilot prospective case-control study. Mothers with preterm deliveries (gestational age <34 wk) were enrolled in two groups- Cases: Those with antenatal risk factors (prolonged duration of rupture of membranes of ≥24 h or chorioamnionitis) and controls: Those without these two risk factors. Serum IgA levels was assayed and microbiological culture was tested in UCB samples. 16S sequencing to determine the UCB microbiome was performed in a subset of samples (n = 15). Neonates were followed-up for the occurrence of EOS or death until 7 d of life. RESULTS Forty-nine mothers as cases and 50 mothers as controls were consecutively enrolled. No significant difference was observed in the IgA levels (60.5 vs. 58.1 mg/L; p = 0.71), neonatal blood culture positivity (4.1% vs. 8.0%; p = 0.41) and UCB culture positivity (30.6% vs. 26.0%; p = 0.61) in the two groups. No difference was observed between the groups in occurrence of EOS or death within 7 d of life. Proteobacteria, Firmicutes and Actinobacteria were the most abundant phyla. Serratia, Bifidobacterium, Collinsella, Meganomas and Blautia being the most common genera. CONCLUSIONS Cord blood IgA concentration could not differentiate the neonates at-risk of infection due to its presence in both the groups.
Collapse
Affiliation(s)
- Ashish Jain
- Department of Neonatology, Central Health Service, Maulana Azad Medical College, (University of Delhi), Govt. of India, New Delhi, India
| | - Kajal Jain
- Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Health, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Divashree Jhurani
- Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Health, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Asha Mishra
- Department of Gastroenterology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sarita Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Akash Sharma
- Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Health, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vikas Manchanda
- Department of Microbiology, Central Health Service, Maulana Azad Medical College, (University of Delhi), Govt. of India, New Delhi, India
| | - M Jeeva Sankar
- Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Health, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ramesh Agarwal
- Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Health, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| |
Collapse
|
9
|
Agarwal A, Chakma N, Manchanda V, Dabas A. Virological profile of upper respiratory tract infections in children under 5 years of age- a cross sectional study in a tertiary care hospital in North India. Indian J Med Microbiol 2023; 44:100378. [PMID: 37356837 DOI: 10.1016/j.ijmmb.2023.100378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/26/2023] [Accepted: 04/20/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To study the virological profile of URI among children under 5 years of age. Since, it is very difficult to distinguish between various viral etiologies solely on the basis of symptoms, this study was attempted to generate evidence that majority of URI are caused due to viral illness and no antibiotics should be prescribed in the management of the same. METHODS This observational study was conducted over a period of one year (June 2021-May 2022) in a tertiary care teaching hospital in New Delhi. A total of 180 children between the age of 0-5 years with symptoms of URI were included. Nasopharyngeal swabs were taken and processed for detection of viruses using multiplex RT PCR. RESULTS Presence of viruses were detected in 136 (75.6%) samples. A single virus was identified in 113 samples, whereas 21 were found to harbour two viruses and 2 were carrying three viruses. The most common virus isolated was Human Rhinovirus (HRV- 55.8%) followed by Respiratory Syncytial Virus (RSV- 23.5%). In samples showing coinfection with two viruses, most common was Human Corona Virus (HCoV)- NL63, 229E, OC43, HKU1. None of the patients were given antibiotics. None of the patients required any hospital admission for severe respiratory illness. CONCLUSIONS Viruses are a major cause of URI in children under five years of age, with the most prevalent organisms being HRV and RSV. Antibiotic prescriptions in URI are not warranted.
Collapse
Affiliation(s)
- Anurag Agarwal
- Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
| | - Navankur Chakma
- Department of Paediatrics, Maulana Azad Medical College, New Delhi, India.
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Aashima Dabas
- Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
10
|
Gupta A, Adarsh T, Manchanda V, Sasmal PK, Gupta S. COVID-19 detection using AIE-active iridium complexes. Dalton Trans 2023; 52:1188-1192. [PMID: 36656120 DOI: 10.1039/d2dt03554e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The highly contagious COVID-19, caused by the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is commonly diagnosed using reverse transcription polymerase chain reaction (RT-PCR). However, despite being highly sensitive, RT-PCR is also time consuming and quite complex, which limits its use for point-of-care (POC) testing. We have developed a simple single-step fluorescence assay for SARS-CoV-2 RNA detection based on the principle of aggregation-induced emission (AIE) using iridium complexes. Our smartly designed iridium probes fluorescently "turn-on" in the presence of SARS-CoV-2 RNA and give specific results at room temperature within 10 min. The lower limit of detection (LOD) is 1.84 genome copies per reaction, and the sensitivity and specificity of the assay in 20 clinical samples are found to be 90% and 80%, respectively.
Collapse
Affiliation(s)
- Ajay Gupta
- School of Physical Sciences, Jawaharlal Nehru University, New Delhi 110067, India.
| | - Tarun Adarsh
- Department of Chemical Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India.
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India
| | - Pijus K Sasmal
- School of Physical Sciences, Jawaharlal Nehru University, New Delhi 110067, India.
| | - Shalini Gupta
- Department of Chemical Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India.
| |
Collapse
|
11
|
Gupta P, Lal P, Manchanda V. Microbial profile from peritoneal fluid and surgical wounds in patients with perforation peritonitis - A cross-sectional study from New Delhi. Trop Doct 2023; 53:218-221. [PMID: 36648163 DOI: 10.1177/00494755221150537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Surgical site infection (SSI) remains one of the most common complications of perforation peritonitis, contributing not only to morbidity but also mortality. We studied the culture and sensitivity of intra-peritoneal fluid and post-operative laparotomy wounds, and found consistency in pathogen and sensitivity between the intra and post-operative samples in 25 cases (80.6%). Therefore, routine culture and sensitivity of peritoneal fluid and subsequently switching the empirical anti-microbial therapy accordingly is justified.
Collapse
Affiliation(s)
- Princy Gupta
- Department of Surgery, Lok Nayak Hospital, Delhi, India
| | | | - Vikas Manchanda
- Department of Microbiology, 28862Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
| |
Collapse
|
12
|
Shreya S, Chawla R, Anuradha S, Singh MM, Manchanda V, Saxena S. Proportion of syphilis and hepatitis B and C virus infections among the Integrated Counselling and Testing Centre attendees of a tertiary care hospital. Indian J Sex Transm Dis AIDS 2023; 44:35-39. [PMID: 37457542 PMCID: PMC10343129 DOI: 10.4103/ijstd.ijstd_113_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Human Immunodeficiency Virus (HIV) affects the immune system of the body, causing a breakdown in its normal defenses and leaving it vulnerable to a host of life-threatening diseases. High-risk behaviors and routes of transmission for sexually transmitted infections such as syphilis, hepatitis B and hepatitis C are identical with HIV. This study was conducted to assess the proportion of syphilis and hepatitis B and C virus infections in HIV-positive and HIV-negative individuals, and their association with socioeconomic and other factors in Integrated Counselling and Testing Centre (ICTC) attendees, and to determine the association of absolute CD4+ T-lymphocyte count with these co-infections in HIV-positive individuals. Materials and Methods The study was conducted in the Department of Microbiology of a tertiary care hospital. It included 100 HIV-positive individuals and 100 matched HIV-negative controls attending the ICTC. HIV-positive patients on antiretroviral therapy and patients with history of current/past treatment for chronic hepatitis infection were excluded from the study. Blood samples were tested for HIV, syphilis, and hepatitis B and C infections. Results The prevalence of syphilis, hepatitis B, and hepatitis C was observed in 3.5%, 2%, and 10% of patients, respectively. The frequency of hepatitis B virus (HBV) infection in HIV-positive and HIV-negative individuals was 1% and 3%, respectively. Hepatitis C virus (HCV) infection among HIV-positive and HIV-negative patients was 16% and 4%, respectively. Syphilis was seen in 7% of the HIV-infected patients. The mean CD4+ count for the HIV-positive patients with either syphilis, HBV, or HCV infections was 252 ± 137.5 cells/μl. Significant associations between HIV infection and education below high school, IV drug abuse, and multiple sexual partners were observed. Conclusions The HIV-infected patients were observed to be at an increased risk of acquiring syphilis and HCV co-infections through the shared routes of transmission. Routine screening of these patients for concurrent syphilis and viral hepatitis may aid in prompt diagnosis and treatment with improved outcomes, which in turn may decrease the further spread of these infections.
Collapse
Affiliation(s)
- Sunidhi Shreya
- Department of Microbiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Rohit Chawla
- Department of Microbiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - S. Anuradha
- Department of Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Mongjam Meghachandra Singh
- Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| |
Collapse
|
13
|
Muacevic A, Adler JR, Kumar S, Jaisingh K, R. AT, Rao KC, Chhabra K, Saxena S, Manchanda V, Sharma S. Optical Coherence Tomography Angiography Parameters of the Retina in SARS-CoV-2 Recovered Subjects. Cureus 2023; 15:e33548. [PMID: 36779162 PMCID: PMC9907863 DOI: 10.7759/cureus.33548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION This study aims to evaluate retinochoroidal optical coherence tomography angiography (OCTA) parameters in patients recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS This study was an observational study that included 80 subjects being discharged after having negative reports on the reverse transcription-polymerase chain reaction (RT-PCR) test for SARS-CoV-2 to evaluate OCTA parameters of the retina. The subjects underwent an ophthalmic evaluation that included best-corrected visual acuity (BCVA), intraocular pressure (IOP), color vision (CV), contrast sensitivity (CS), and optical coherence tomography (OCT) parameters. OCTA was done for all patients and was evaluated for foveal avascular zone (FAZ) area, perimeter, and circularity index, and vessel density (VD) in superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina (OR), outer retina chorio-capillaries (ORCC), chorio-capillaries (CC), and choroid (C) using 3 x 3 mm scans. The OCTA parameters were compared with normative data of the Indian population for various parameters in question. RESULTS The subjects included 54/80 (67.5%) males and 26/80 (32.5%) females having a mean age of 52.40 ± 15.71 (18-60) years. The systemic evaluation revealed 38.75% of subjects had hypertension, 30% had diabetes, 20% had kidney disease, 5% had tuberculosis, and 3.75% had coronary artery disease. The mean distance BCVA was logarithm of the minimum angle of resolution (LogMAR) (1.17 ± 0.22), mean IOP was 17.0 ± 4.0 mmHg, mean CS was 2.13 ± 0.36, 50.62% of subjects had normal CV on Farnsworth test while 47% had tritanopia, and none of the subjects had red-green CV defect on Ishihara plates. The OCT scan was normal in 90% of eyes while the posterior vitreous detachment was seen in 4% of eyes, broad vitreomacular adhesion in 2.5% of eyes, and the globally adherent epiretinal membrane was seen in 2.5% of eyes. The mean central macular thickness (CMT) measured 245.14 ± 28.41 micrometers. The mean FAZ area measured 0.37 ± 0.15 mm2, the perimeter was 3.28 ± 1.08 mm, and the circularity index measured 0.41 ± 0.10. The average VD in SCP measured 16.06 ± 12.29, in DCP measured 9.11 ± 8.75, in OR measured 6.38 ± 7.37, in ORCC measured 42.53 ± 12.46, in CC measured 25.83 ± 16.31, and in C measured 25.52 ± 17.49. The VD in coronavirus disease 2019 (COVID-19) subjects was significantly lesser than that in the healthy Indian population in all layers except ORCC. CONCLUSIONS The SARS-CoV-2 recovered subjects have a reduced VD in retinochoroidal layers from COVID-19, an underlying systemic disease, or both. The CS values fall within normal limits. Several subjects show tritanopia on the Farnsworth test but no red-green CV defect on Ishihara plates.
Collapse
|
14
|
Irungbam M, Chitkara A, Singh VK, Sonkar SC, Dubey A, Bansal A, Shrivastava R, Goswami B, Manchanda V, Saxena S, Saxena R, Garg S, Husain F, Talukdar T, Kumar D, Koner BC. Evaluation of Performance of Detection of Immunoglobulin G and Immunoglobulin M Antibody Against Spike Protein of SARS-CoV-2 by a Rapid Kit in a Real-Life Hospital Setting. Front Microbiol 2022; 13:802292. [PMID: 35558113 PMCID: PMC9087894 DOI: 10.3389/fmicb.2022.802292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background Antibody testing is often used for serosurveillance of coronavirus disease 2019 (COVID-19). Enzyme-linked immunosorbent assay and chemiluminescence-based antibody tests are quite sensitive and specific for such serological testing. Rapid antibody tests against different antigens are developed and effectively used for this purpose. However, their diagnostic efficiency, especially in real-life hospital setting, needs to be evaluated. Thus, the present study was conducted in a dedicated COVID-19 hospital in New Delhi, India, to evaluate the diagnostic efficacy of a rapid antibody kit against the receptor-binding domain (RBD) of the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods Sixty COVID-19 confirmed cases by reverse transcriptase–polymerase chain reaction (RT-PCR) were recruited and categorized as early, intermediate, and late cases based on the days passed after their first RT-PCR–positive test report, with 20 subjects in each category. Twenty samples from pre-COVID era and 20 RT-PCR–negative collected during the study period were taken as controls. immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies against the RBD of the spike (S) protein of SARS-CoV-2 virus were detected by rapid antibody test and compared with the total antibody against the nucleocapsid (N) antigen of SARS-CoV-2 by electrochemiluminescence-based immunoassay (ECLIA). Results The detection of IgM against the RBD of the spike protein by rapid kit was less sensitive and less specific for the diagnosis of SARS-CoV-2 infection. However, diagnostic efficacy of IgG by rapid kit was highly sensitive and specific when compared with the total antibody against N antigen measured by ECLIA. Conclusion It can be concluded that detection of IgM against the RBD of S protein by rapid kit is less effective, but IgG detection can be used as an effective diagnostic tool for SARS-CoV-2 infection in real-life hospital setting.
Collapse
Affiliation(s)
- Monica Irungbam
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Anubhuti Chitkara
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Vijay Kumar Singh
- Multidisciplinary Research Unit (MRU), Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Subash Chandra Sonkar
- Multidisciplinary Research Unit (MRU), Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Abhisek Dubey
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Aastha Bansal
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Ritika Shrivastava
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, India.,Multidisciplinary Research Unit (MRU), Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Ritu Saxena
- Emergency Department, Lok Nayak Jai Prakash Narayan (LNJP) Hospital, New Delhi, India
| | - Sandeep Garg
- Department of Medicine, Lok Nayak Jai Prakash Narayan (LNJP) Hospital, New Delhi, India
| | - Farah Husain
- Department of Anesthesiology, Lok Nayak Jai Prakash Narayan (LNJP) Hospital, New Delhi, India
| | - Tanmay Talukdar
- Department of TB & Chest Diseases/Pulmonary Medicine, Lady Hardinge Medical College (LHMC), New Delhi, India
| | - Dinesh Kumar
- Food Safety and Standards Authority of India, Ministry of Health and Family Welfare (MoHFW), New Delhi, India
| | - Bidhan Chandra Koner
- Department of Biochemistry, Maulana Azad Medical College and Associated Hospitals, New Delhi, India.,Multidisciplinary Research Unit (MRU), Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| |
Collapse
|
15
|
Vijayakumar S, Garg S, Garg A, Aggarwal S, Manchanda V, Singh R, Kumar S. Correlation between NEWS, CT Severity Score and RT-PCR Cycle Threshold Value among Mild and Moderate COVID-19 Patients. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/56743.16876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: The clinical diagnosis of COVID-19 is supplemented by clinical severity indices. These indices are the National Early Warning Score (NEWS, which aids in risk stratification), CT severity score (radiological severity score), and Reverse TranscriptionPolymerase Chain Reaction (RT-PCR) cycle threshold (Ct value, which provides a semi-quantitative measure of viral load). Aim: To assess the correlation between NEWS at admission, RT-PCR Ct value and CT severity score in mild and moderate COVID-19 patients. Methods and Materials: This prospective cohort study was conducted in Maulana Azad Medical College and Lok Nayak hospital, New Delhi, from January to June 2021. The study included 50 subjects (25 with mild COVID-19 and 25 with moderate COVID-19). NEWS was calculated at admission and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ct value was estimated using real-time RT-PCR. CT severity score was calculated based on High Resolution Computed Tomography (HRCT) chest findings. The correlation among the parameters was determined using Pearson correlation formula. Results: The mean age of subjects in the mild and moderate COVID-19 groups were 49.52 years and 51.84 years, respectively. The mean RT-PCR Ct value of E gene was 24.48 and Rdrp gene was 24.56 in the mild COVID-19 group; while in the moderate group it was 23.72 for both E gene and Rdrp genes. The correlation between NEWS and Ct value of E gene (r-value=-0.06, p-value=0.68), Ct value of Rdrp gene (r-value=- 0.03, p-value=0.79) and the correlation between CT severity score and Ct value of E gene (r-value=-0.05, p-value=0.73), Ct value of Rdrp gene (r-value=-0.06, p-value=0.68) was negative and insignificant. The mean CT severity score in mild COVID-19 group was 3.92, and in moderate COVID-19 group was 9.88. A significant positive correlation was found between the CT severity score and NEWS at admission. Conclusion: The clinical severity of COVID-19 as estimated by NEWS corroborates with CT severity score while the relationship between RT-PCR Ct value and clinicoradiological severity needs to be ascertained by further research.
Collapse
|
16
|
Meher R, Wadhwa V, Kumar V, Shisha Phanbuh D, Sharma R, Singh I, Rathore PK, Goel R, Arora R, Garg S, Kumar S, Kumar J, Agarwal M, Singh M, Khurana N, Sagar T, Manchanda V, Saxena S. COVID associated mucormycosis: A preliminary study from a dedicated COVID Hospital in Delhi. Am J Otolaryngol 2022; 43:103220. [PMID: 34547717 PMCID: PMC8432976 DOI: 10.1016/j.amjoto.2021.103220] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/05/2021] [Indexed: 11/28/2022]
Abstract
Background It is an incontrovertible fact that the Rhino Orbital Cerebral Mucormycosis (ROCM) upsurge is being seen in the context of COVID-19 in India. Briefly presented is evidence that in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 and injudicious use of corticosteroids may be largely responsible for this malady. Objective To find the possible impact of COVID 19 infection and various co-morbidities on occurrence of ROCM and demonstrate the outcome based on medical and surgical interventions. Methodology. Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID-19 infection. Diagnostic nasal endoscopy (DNE) was performed on each patient and swabs were taken and sent for fungal KOH staining and microscopy. Medical management included Injection Liposomal Amphotericin B, Posaconazole and Voriconazole. Surgical treatment was restricted to patients with RT PCR negative results for COVID-19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow-up for survived patients was maintained regularly for the first postoperative month. Results Out of total 131 patients, 111 patients had prior history of SARS COVID 19 infection, confirmed with a positive RT-PCR report and the rest 20 patients had no such history. Steroids were received as a part of treatment in 67 patients infected with COVID 19. Among 131 patients, 124 recovered, 1 worsened and 6 died. Out of 101 known diabetics, 98 recovered and 3 had fatal outcomes. 7 patients with previous history of COVID infection did not have any evidence of Diabetes mellitus, steroid intake or any other comorbidity. Conclusion It can be concluded that ROCM upsurge seen in the context of COVID-19 in India was mainly seen in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 infection and injudicious use of corticosteroids.
Collapse
Affiliation(s)
- Ravi Meher
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vikram Wadhwa
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vikas Kumar
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | | | - Raman Sharma
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Ishwar Singh
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - P K Rathore
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Ruchi Goel
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Ritu Arora
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Sandeep Garg
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Suresh Kumar
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Jyoti Kumar
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Munisha Agarwal
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Meeta Singh
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Nita Khurana
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Tanu Sagar
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vikas Manchanda
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Sonal Saxena
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| |
Collapse
|
17
|
Yadav A, Manchanda V, Tuteja S, Puri D, Saxena S. Invention is the need of the hour: A unique Data Accumulation and Analysis Platform for covid reporting. Indian J Med Microbiol 2021. [DOI: 10.1016/j.ijmmb.2021.08.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Puri D, Manchanda V, Saxena S, Garg S. Mortality review of COVID-19 patients: An experience from the largest dedicated COVID hospital in Delhi. Indian J Med Microbiol 2021. [PMCID: PMC8594420 DOI: 10.1016/j.ijmmb.2021.08.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Arora A, Arora N, Yadav A, Manchanda V. Evaluation of multiple RTPCR kits for detection of SARS CoV-2 RNA. Indian J Med Microbiol 2021. [PMCID: PMC8594415 DOI: 10.1016/j.ijmmb.2021.08.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
20
|
Hasan F, Thakur P, Manchanda V, Saxena S, Rana N. Scenario based Work place based assessment: An innovative teaching tool for hand hygiene and appropriate use of personal protective equipment (PPE). Indian J Med Microbiol 2021. [DOI: 10.1016/j.ijmmb.2021.08.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
21
|
Shreya S, Yadav A, Sagar T, Manchanda V, Nishad J. Persistence of SARS-CoV-2 on surfaces in Patient care units and Laboratory in a dedicated COVID-19 hospital in New Delhi. Indian J Med Microbiol 2021. [PMCID: PMC8594322 DOI: 10.1016/j.ijmmb.2021.08.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
22
|
Arora R, Sharda S, Sahu J, Manchanda V, Jain P, Gupta I, Gotmare N, Bharti N. Role of Reverse Transcriptase Polymerase Chain Reaction in Cornea Donors During the COVID-19 Pandemic. Cornea 2021; 40:1044-1047. [PMID: 33935238 PMCID: PMC8244808 DOI: 10.1097/ico.0000000000002742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to report the analysis of reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal (NP) samples of cornea donors dying because of causes unrelated to severe acute respiratory coronavirus (SARS-CoV-2). METHODS A retrospective analysis of all cornea donors dying from causes other than SARS-CoV-2 between August 2020 and December 2020 was performed. Informed consent was obtained from the next of kin of the deceased for RT-PCR testing from NP swabs. Rapid antigen testing from all the deceased was performed before in situ cornea excision. In addition, NP samples in viral transport media for RT-PCR were also collected for SARS-CoV-2 analysis. Corneas were released from the eye bank only after a negative RT-PCR report. RESULT One hundred eighteen corneas from 59 donors were obtained by the eye bank. Eleven donors (18.64%) were positive for SARS-CoV-2 on RT-PCR testing. Six of these 11 donors had a Ct value of E gene less than 25. CONCLUSIONS NP samples of cornea donors dying due to causes other than coronavirus disease-19 were positive for SARS-CoV-2 on RT-PCR. This implicates that donors could be having asymptomatic/undetected coronavirus disease infection. We recommend adding the routine testing of NP samples of all cornea donors in the eye banking protocol in this ongoing SARS-CoV-2 pandemic.
Collapse
Affiliation(s)
- Ritu Arora
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Shipra Sharda
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Jigyasa Sahu
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India.
| | - Parul Jain
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Isha Gupta
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Nikhil Gotmare
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Nisha Bharti
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| |
Collapse
|
23
|
Varghese R, Daniel JL, Neeravi A, Baskar P, Manoharan A, Sundaram B, Manchanda V, Saigal K, Yesudhasan BL, Veeraraghavan B. Multicentric Analysis of Erythromycin Resistance Determinants in Invasive Streptococcus pneumoniae; Associated Serotypes and Sequence Types in India. Curr Microbiol 2021; 78:3239-3245. [PMID: 34223923 DOI: 10.1007/s00284-021-02594-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
Streptococcus pneumoniae is the major cause of childhood pneumonia and related deaths in India. Widespread use of erythromycin for the treatment of pneumonia has led to the emergence of erythromycin resistance. Despite this increase in erythromycin resistance, there are very little data on resistance determinants from India. Hence, we aimed to perform the molecular characterization of erythromycin-resistant invasive pneumococcal isolates in India. In this study, 250 erythromycin-resistant invasive isolates obtained from four Indian hospitals between 2014 and 2019 were included. The isolates were reconfirmed by standard CDC protocols, followed by detection of erm(B), mef(A/E) genes, and screening for mutations in 23S rRNA, ribosomal proteins L4 and L22. Among the 250 erythromycin-resistant isolates, 46% (n = 114) and 35% (n = 87) carried the mef(A/E) gene and erm(B) gene, respectively; both genes were present in 8% (n = 20) of the isolates and 12% (n = 29) of the studied strains did not bear any of them. The major mutations associated with erythromycin resistance in 23S rRNA, such as A2060C, A2061G, and C2613G, were absent. The predominant serotypes were 19F, 14, 23F, 6A, 6B, 19A, and 9V. The major clonal complexes were CC320, followed by CC230 and CC63. The predominant gene was mef(A/E), and most of the serotypes were PCV13 (54%). This study contributes to the baseline understanding of the erythromycin resistance determinants associated with the serotypes and sequence types (ST) of Indian invasive S. pneumoniae.
Collapse
Affiliation(s)
- Rosemol Varghese
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, TN, India
| | - Jones Lionel Daniel
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, TN, India
| | - Ayyanraj Neeravi
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, TN, India
| | - Pavithra Baskar
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, TN, India
| | - Anand Manoharan
- The CHILDS Trust Medical Research Foundation, Chennai, TN, India
| | | | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Karnika Saigal
- Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, Delhi, India
| | - Binesh Lal Yesudhasan
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, TN, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, TN, India.
| |
Collapse
|
24
|
Arora R, Goel R, Saxena S, Manchanda V, Ahmad M, Gupta G, Chhabra M, Kumar S, Nguyen TMN, Payden, Pumma P, Saxena K. Comparative Evaluation of Tears and Nasopharyngeal Swab for SARS-CoV-2 in COVID-19 Dedicated Intensive Care Unit Patients. Ocul Immunol Inflamm 2021; 29:690-696. [PMID: 33974481 DOI: 10.1080/09273948.2021.1903938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To compare the cycle threshold (Ct) values of tears and nasopharyngeal (NP) swab in severe COVID-19 ICU patients with positive NP swabs.Procedure: A cross-sectional study for the detection of SARS-CoV-2 by real-time RT-PCR on simultaneously collected NP swabs and tears was performed. Detailed demographic profile, including comorbidities, ocular, and systemic features were analyzed.Results: In the 78 cases, the mean tear positivity was 26.92% (21/78), 2 tear samples being positive despite a negative NP swab. The mean Ct value of tears and NP were 28.17 ± 4.76 and 23.71 ± 6.19, respectively (p= .003). None of the cases had ocular findings or relationship between tear positivity and comorbidity.Conclusions: The viral load of tears is less than the NP secretions with the possibility of prolonged shedding in tears. Tears act as an additional source of contact transmission in ICU that can possibly be decreased by frequent hand hygiene by the patient.Abbreviations: SARS-CoV-2: Severe acute respiratory syndrome coronavirus; RT-PCR: Real-time Reverse transcriptase-polymerase chain reaction; COVID-19: Corona virus disease 2019; ICU: Intensive care unit; RdRp: RNA-dependent RNA polymerase; ORF 1b: Open reading frame 1b; AIIR: Airborne infection isolation room; HCW: Health care workers; VTM: viral transport media; NP: Nasopharyngeal swab; PPE: Personal protective equipment.
Collapse
Affiliation(s)
- Ritu Arora
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Ruchi Goel
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | | | - Gaurav Gupta
- NPO (Injury and Disability Prevention), WHO, India
| | - Mohit Chhabra
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sumit Kumar
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | | | - Payden
- Deputy Country Head, WHO, India
| | - Palak Pumma
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Kirti Saxena
- Department of Anaesthesiology, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
25
|
Dubey A, Kotnala G, Mandal TK, Sonkar SC, Singh VK, Guru SA, Bansal A, Irungbam M, Husain F, Goswami B, Kotnala RK, Saxena S, Sharma SK, Saxena KN, Sharma C, Kumar S, Aswal DK, Manchanda V, Koner BC. Evidence of the presence of SARS-CoV-2 virus in atmospheric air and surfaces of a dedicated COVID hospital. J Med Virol 2021; 93:5339-5349. [PMID: 33913527 PMCID: PMC8242543 DOI: 10.1002/jmv.27029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/11/2021] [Accepted: 04/11/2021] [Indexed: 12/23/2022]
Abstract
The present study was conducted from July 1, 2020 to September 25, 2020 in a dedicated coronavirus disease 2019 (COVID‐19) hospital in Delhi, India to provide evidence for the presence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus in atmospheric air and surfaces of the hospital wards. Swabs from hospital surfaces (patient's bed, ward floor, and nursing stations area) and suspended particulate matter in ambient air were collected by a portable air sampler from the medicine ward, intensive care unit, and emergency ward admitting COVID‐19 patients. By performing reverse‐transcriptase polymerase chain reaction (RT‐PCR) for E‐gene and RdRp gene, SARS‐CoV‐2 virus was detected from hospital surfaces and particulate matters from the ambient air of various wards collected at 1 and 3‐m distance from active COVID‐19 patients. The presence of the virus in the air beyond a 1‐m distance from the patients and surfaces of the hospital indicates that the SARS‐CoV‐2 virus has the potential to be transmitted by airborne and surface routes from COVID‐19 patients to health‐care workers working in COVID‐19 dedicated hospital. This warrants that precautions against airborne and surface transmission of COVID‐19 in the community should be taken when markets, industries, educational institutions, and so on, reopen for normal activities.
Collapse
Affiliation(s)
- Abhishek Dubey
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Garima Kotnala
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Tuhin K Mandal
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Subash C Sonkar
- Multidisciplinary Research Unit, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Vijay K Singh
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Sameer A Guru
- Multidisciplinary Research Unit, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Aastha Bansal
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Monica Irungbam
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Farah Husain
- Department of Anesthesia, Lok Nayak Hospital, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India.,Multidisciplinary Research Unit, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Ravindra K Kotnala
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Sudhir K Sharma
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Kirti N Saxena
- Department of Anesthesia, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Chhemendra Sharma
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Suresh Kumar
- Department of Medicine, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Dinesh K Aswal
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Bidhan C Koner
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India.,Multidisciplinary Research Unit, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| |
Collapse
|
26
|
Thakur P, Saxena S, Manchanda V, Rana N, Goel R, Arora R. Utility of Antigen-Based Rapid Diagnostic Test for Detection of SARS-CoV-2 Virus in Routine Hospital Settings. Lab Med 2021; 52:e154-e158. [PMID: 33928384 PMCID: PMC8135470 DOI: 10.1093/labmed/lmab033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective This study aims to evaluate the performance of an antigen-based rapid diagnostic test (RDT) for the detection of the SARS-CoV-2 virus. Methods A cross-sectional study was conducted on 677 patients. Two nasopharyngeal swabs and 1 oropharyngeal swab were collected from patients. The RDT was performed onsite by a commercially available immune-chromatographic assay on the nasopharyngeal swab. The nasopharyngeal and oropharyngeal swabs were examined for SARS-CoV-2 RNA by real-time reverse-transcription quantitative polymerase chain reaction (RT-qPCR) assay. Results The overall sensitivity of the SARS-CoV-2 RDT was 34.5% and the specificity was 99.8%. The positive predictive value and negative predictive value of the test were 96.6% and 91.5%, respectively. The detection rate of RDT in RT-qPCR positive results was high (45%) for cycle threshold values <25. Conclusion The utility of RDT is in diagnosing symptomatic patients and may not be particularly suited as a screening tool for patients with low viral load. The low sensitivity of RDT does not qualify its use as a single test in patients who test negative; RT-qPCR continues to be the gold standard test.
Collapse
Affiliation(s)
- Preeti Thakur
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Neha Rana
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Ruchi Goel
- Department of Ophthalmology, Guru Nanak Eye Center, New Delhi, India
| | - Ritu Arora
- Department of Ophthalmology, Guru Nanak Eye Center, New Delhi, India
| |
Collapse
|
27
|
Saxena S, Manchanda V, Sagar T, Nagi N, Siddiqui O, Yadav A, Arora N, Hasan F, Meena K, Bharti P, Rana N, Hayat S, Tuteja S, Yadav A, Puri D, Pumma P, Khyati, Arora A, Jainandra, Shreya S, Kumar S, Sharma N. Clinical characteristic and epidemiological features of SARS CoV -2 disease patients from a COVID 19 designated Hospital in New Delhi. J Med Virol 2021; 93:2487-2492. [PMID: 33410174 DOI: 10.1002/jmv.26777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/01/2021] [Indexed: 01/08/2023]
Abstract
SARS CoV -2 infection is rapidly evolving as a serious global pandemic. The present study describes the clinical characteristics of SARS CoV-2 infection patients. The Samples were subjected to RT - PCR or Rapid Antigen test for diagnosis of SARS CoV- 2. A cohort of 3745 patients with confirmed diagnosis of SARS CoV -2 infection in a tertiary care center in New Delhi, India were included in this study. Data was collected from offline and online medical records over a period of six months. Amongst 3745 SARS CoV -2 infected patients, 2245 (60%) were symptomatic and 1500 (40%) were asymptomatic. Most common presenting symptom was cough (49.3%) followed febrile episodes (47.1%), breathlessness (42.7%) and sore throat (35.1%). Cough along with breathlessness (24.1) was the most common combination of symptoms followed by fever with cough (22.7). The most common comorbidity found among symptomatic group was diabetes (42.5%) followed by hypertension (21.4%) and chronic kidney disease (18%). Comorbidities like diabetes mellitus, chronic diseases of lungs, heart and kidneys were found to be common in symptomatic group and this was found to be statistically significant (p<0.05). COVID-19 is an evolving disease and data from our study help in understanding the clinic-epidemiological profile of patients. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Tanu Sagar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Nazia Nagi
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Oves Siddiqui
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Abhishek Yadav
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Nitin Arora
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Faria Hasan
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Kavita Meena
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Pradeep Bharti
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Neha Rana
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Sikander Hayat
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Sanchita Tuteja
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Ajeet Yadav
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Devyani Puri
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Palak Pumma
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Khyati
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Ananya Arora
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Jainandra
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Sunidhi Shreya
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | | | | |
Collapse
|
28
|
Gupta S, Manchanda V, Sachdev P, Kumar Saini R, Joy M. Study of incidence and risk factors of surgical site infections in lower segment caesarean section cases of tertiary care hospital of north India. Indian J Med Microbiol 2020; 39:1-5. [PMID: 33610238 DOI: 10.1016/j.ijmmb.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the incidence density, risk factors and common pathogens associated with surgical site infections (SSI) following lower segment caesarean section (LSCS) surgeries. METHODS In this Non-interventional prospective observational study, a total of 611 post caesarean emergency and elective cases were enrolled among the 1018 LSCS cases conducted for the period of May-August 2016. The demographic, risk factors and clinical data for appearance of signs and symptoms of SSI were recorded in a preformatted proforma. SSI's were classified as superficial, deep and organ space as per Centre for Disease Control (CDC), USA definitions. Pus specimens were processed and antimicrobial susceptibility results of the organisms were determined as standard microbiological techniques. RESULTS The SSI rate was found to be 10.3 per 100 surgeries in our study with superficial SSI (66.7%) being most common. Inappropriate pre-surgical antibiotic prophylaxis, anaemia, previous LSCS as indication of LSCS, intra-operative blood transfusion and comorbid illness like heart disease, hypothyroidism, chronic liver and kidney disease were found to be significantly associated with SSI. Predominance of gram negative isolates (55.3%) was seen in comparison to gram positive isolates (44.7%) as cause of surgical site infections. CONCLUSIONS SSIs rates observed are much higher than those observed in NHSN participating hospitals. Many of the risk factors identified are low hanging fruits and can be targeted to effectively reduce SSI rates.
Collapse
Affiliation(s)
- Shilpi Gupta
- Department of Microbiology Maulana Azad Medical College and Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
| | - Vikas Manchanda
- Department of Microbiology Maulana Azad Medical College and Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
| | - Poonam Sachdev
- Department of Obstetrics and Gynecology Lok Nayak Hospital, New Delhi, 110002, India.
| | - Rajesh Kumar Saini
- Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
| | - Minimol Joy
- Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
| |
Collapse
|
29
|
Affiliation(s)
- Ruchi Goel
- Guru Nanak Eye Centre, New Delhi, India. E-mail:
| | - Ritu Arora
- Guru Nanak Eye Centre, New Delhi, India. E-mail:
| | | | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Palak Pumma
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
30
|
Arora R, Goel R, Kumar S, Chhabra M, Saxena S, Manchanda V, Pumma P. Evaluation of SARS-CoV-2 in Tears of Patients with Moderate to Severe COVID-19. Ophthalmology 2020; 128:494-503. [PMID: 32882309 PMCID: PMC7458068 DOI: 10.1016/j.ophtha.2020.08.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/14/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate the presence of SARS-CoV-2 RNA in tears of patients with moderate to severe coronavirus disease 2019 (COVID-19). DESIGN Cross-sectional study. PARTICIPANTS Patients with laboratory-proven moderate to severe COVID-19. METHODS Tears were collected within 48 hours of laboratory confirmation using 3 methods: conjunctival swab plus Schirmer's test strips (group 1), conjunctival swab (group 2), and Schirmer's test strips (group 3). Samples from both the eyes of each patient were transported in a single viral transport media for real-time RT-PCR. Detailed demographic profiles, systemic symptoms, comorbidities, and ocular manifestations were noted. MAIN OUTCOME MEASURES Viral load of a sample was determined using cycle threshold (Ct) value of E gene. A specimen was considered to show positive results if the amplification curve for the E gene crossed the threshold line within 35 cycles and if it showed positive results on an RNA-dependent RNA polymerase or open reading frame 1b gene assay. RESULTS Of the 78 patients enrolled in the study, samples from 3 patients were found to be inadequate for analysis. Thirty-six patients (48%) had moderate disease, whereas 39 patients (52%) had severe disease, with no ocular involvement in any patient. In the 75 patients, RT-PCR analysis of tears showed positive results in 18 patients (24%), and 29 of 225 samples (12.9%) showed positive results. Positive results were found in 11 (14.7%), 11 (14.7%), and 7 (9.3%) patients in groups 1, 2, and 3, respectively (P = 0.3105). Mean Ct values in groups 1, 2, and 3 were 28.36 ± 6.15, 29.00 ± 5.58, and 27.86 ± 6.46 (P = 0.92), respectively. Five patients showed positive RT-PCR results by all 3 methods (mean Ct value, 25.24 ± 6.33), and 12 patients showed positive results by any of the 3 methods (mean Ct value, 32.16 ± 1.94), the difference in Ct values being statistically significant (P = 0.029). The median value of symptomatology in patients with positive RT-PCR results from tears was 5 days (range, 4-9 days). CONCLUSIONS SARS-CoV-2 RNA was detected in tears of 24% of patients with laboratory-proven moderate to severe COVID-19. Conjunctival swab remains the gold standard of tear collection for RT-PCR assay. A significantly higher possibility of viral transmission exists through tears in patients with moderate to severe COVID-19.
Collapse
Affiliation(s)
- Ritu Arora
- Guru Nanak Eye Centre, Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Ruchi Goel
- Guru Nanak Eye Centre, Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India.
| | - Sumit Kumar
- Guru Nanak Eye Centre, Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Mohit Chhabra
- Guru Nanak Eye Centre, Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Palak Pumma
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
31
|
Siddiqui O, Manchanda V, Yadav A, Sagar T, Tuteja S, Nagi N, Saxena S. Comparison of two real-time polymerase chain reaction assays for the detection of severe acute respiratory syndrome-CoV-2 from combined nasopharyngeal-throat swabs. Indian J Med Microbiol 2020; 38:385-389. [PMID: 33154251 PMCID: PMC7709598 DOI: 10.4103/ijmm.ijmm_20_279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/06/2020] [Indexed: 01/04/2023]
Abstract
CONTEXT In the absence of effective treatment or vaccine, the current strategy for the prevention of further transmission of severe acute respiratory syndrome (SARS) CoV-2 (COVID-19) infection is early diagnosis and isolation of cases. The diagnosis of SARS-CoV-2 is done by detecting viral RNA in the nasopharyngeal and throat swabs by real-time polymerase chain reaction (PCR). Many commercial assays are now available for performing the PCR assay. AIMS The aim was to evaluate the performance of the SD Biosensor nCoV real-time detection kit with the real-time PCR kit provided by the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pune (NIV Protocol). SUBJECTS AND METHODS A total of 253 pairs of nasopharyngeal-oropharyngeal swabs combined in a single viral transport medium were tested for viral RNA by both the protocols. The sensitivity and specificity of the SD Biosensor were calculated considering the ICMR-NIV kit as the gold standard. Matched pairs of recorded cycle threshold values (Ct values) were compared by Pearson's correlation coefficient. RESULTS Concordant COVID-19 negative and positive PCR results were reported for 113 and 77 samples, respectively. The SD Biosensor kit additionally detected 62 cases, which were found negative by the NIV protocol. In all discordant positive results by the SD Biosensor kit, the average Ct values were higher than the concordant positive results. A total of forty samples tested positive for E gene by SD Biosensor and having Ct values <25 had 100% concordance with NIV protocol results and 39 samples tested positive for E gene by SD Biosensor having Ct value >32 were all found negative by the NIV protocol. CONCLUSIONS The results highlight the need for careful evaluation of commercial kits before being deployed for screening of COVID-19 infections.
Collapse
Affiliation(s)
- Oves Siddiqui
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Abhishek Yadav
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Tanu Sagar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Sanchita Tuteja
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Nazia Nagi
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
32
|
Kumar M, Ghunawat J, Saikia D, Manchanda V. Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome. ACTA ACUST UNITED AC 2020; 41:526-533. [PMID: 31528983 PMCID: PMC6979567 DOI: 10.1590/2175-8239-jbn-2019-0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/11/2019] [Indexed: 01/03/2023]
Abstract
Introduction: Children with nephrotic syndrome are at increased risk of infections because of disease status itself and use of various immunosuppressive agents. In majority, infections trigger relapses requiring hospitalization with increased risk of morbidity and mortality. This study aimed to determine the incidence, spectrum, and risk factors for major infections in hospitalized children with nephrotic syndrome. Methods: All consecutive hospitalized children between 1-12 years of age with nephrotic syndrome were enrolled in the study. Children with acute nephritis, secondary nephrotic syndrome as well as those admitted for diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion were excluded. Results: A total of 148 children with 162 admissions were enrolled. Incidence of major infections in hospitalized children with nephrotic syndrome was 43.8%. Peritonitis was the commonest infection (24%), followed by pneumonia (18%), urinary tract infection (15%), and cellulitis (14%), contributing with two thirds of major infections. Streptococcus pneumoniae (n = 9) was the predominant organism isolated in children with peritonitis and pneumonia. On logistic regression analysis, serum albumin < 1.5gm/dL was the only independent risk factor for all infections (OR 2.6; 95% CI, 1.2-6; p = 0.01), especially for peritonitis (OR 29; 95% CI, 3-270; p = 0.003). There were four deaths (2.5%) in our study, all due to sepsis and multiorgan failure. Conclusions: Infection remains an important cause of morbidity and mortality in children with nephrotic syndrome. As Pneumococcus was the most prevalent cause of infection in those children, attention should be paid to the pneumococcal immunization in children with nephrotic syndrome.
Collapse
Affiliation(s)
- Manish Kumar
- Chacha Nehru Bal Chikitsalaya, Department of Pediatrics and Microbiology, New Delhi, Delhi, India
| | - Jaypalsing Ghunawat
- Chacha Nehru Bal Chikitsalaya, Department of Pediatrics and Microbiology, New Delhi, Delhi, India
| | - Diganta Saikia
- Chacha Nehru Bal Chikitsalaya, Department of Pediatrics and Microbiology, New Delhi, Delhi, India
| | - Vikas Manchanda
- Chacha Nehru Bal Chikitsalaya, Department of Pediatrics and Microbiology, New Delhi, Delhi, India
| |
Collapse
|
33
|
Rai S, Tandon M, Singh NP, Manchanda V, Kaur IR. Development, optimization, standardization, and validation of a simple in-house agar gradient method to determine minimum inhibitory concentration of vancomycin for Staphylococcus aureus. J Lab Physicians 2019; 11:220-228. [PMID: 31579244 PMCID: PMC6771310 DOI: 10.4103/jlp.jlp_11_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND: The Clinical and Laboratory Standards Institute recommends reporting minimum inhibitory concentration (MIC) values of vancomycin for Staphylococcus aureus. Commercial MIC strips are expensive, and the traditional broth microdilution method is cumbersome. With this background, we attempted to develop and standardize an in-house agar gradient method to determine MIC values of vancomycin for S. aureus. OBJECTIVES: To develop and validate an in-house vancomycin MIC strip, based on simple agar gradient method for S. aureus as per bioassay development guidelines. MATERIALS AND METHODS: Filter paper gradient strips were made in house and impregnated with varying concentrations of vancomycin to create an antibiotic gradient. During standardization, MICs of ninety clinical strains of S. aureus and ATCC 29213 were tested by the broth microdilution and commercial strip followed by the in-house strip. During the validation stage, MICs of ninety different clinical strains of S. aureus and ATCC 29213 were determined by the in-house strip followed by MIC detection by broth microdilution and commercial strips. A reading of more than ± 1log2 dilution compared with broth microdilution was considered as an outlier. RESULTS: During the initial stage, there were 7/90 outliers in the clinical strains, and no outliers were seen with the ATCC 29213 control strain. Corrective action included increasing precaution during the antibiotic impregnation on the strip. During validation stage, only 4/90 outliers were observed in the clinical strains. The commercial strips had 29/90 among clinical and 15/30 outliers in the control strain during the prevalidation phase. Despite maintaining cold chain during the validation phase, the outliers for commercial strip were 18/90 and 4/30 for clinical and control strains, respectively. CONCLUSION: Reporting vancomycin MIC for S. aureus may be attempted using the in-house method after validating it with a gold standard broth microdilution method and quality control as per protocol.
Collapse
Affiliation(s)
- Sumit Rai
- Department of Clinical Microbiology, Super Specialty Pediatric Hospital and Post Graduate Teaching Institute, Noida, Uttar Pradesh, India
| | - Mukta Tandon
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Narendra Pal Singh
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Vikas Manchanda
- Department of Clinical Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Iqbal Rajinder Kaur
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| |
Collapse
|
34
|
Jayaraman Y, Mehendale S, Jayaraman R, Varghese R, Chethrapilly Purushothaman GK, Rajkumar P, Sukumar B, Pillai RK, Mohan G, Radhakrishnan DN, Sridharan S, Babu N, Ganesapillai M, Rao SP, Kar SK, Manchanda V, Kanga A, Verghese VP, Veeraraghavan B. Immunochromatography in CSF improves data on surveillance of S. pneumoniae meningitis in India. J Infect Public Health 2018; 11:735-738. [DOI: 10.1016/j.jiph.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 12/30/2017] [Accepted: 01/03/2018] [Indexed: 10/17/2022] Open
|
35
|
Sharma S, Uppal B, Manchanda V, Sud A. Diagnostic utility of procalcitonin as biomarker of sepsis in children. Infect Dis (Lond) 2018; 50:567-568. [DOI: 10.1080/23744235.2018.1453170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Swati Sharma
- Department of Microbiology, Janakpuri Superspeciality Hospital, Delhi, India
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Beena Uppal
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
- Department of Microbiology, Dr Baba Saheb Ambedkar Medical College, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
| | - Anuj Sud
- Department of Microbiology, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
36
|
Jajoo M, Manchanda V, Chaurasia S, Sankar MJ, Gautam H, Agarwal R, Yadav CP, Aggarwal KC, Chellani H, Ramji S, Deb M, Gaind R, Kumar S, Arya S, Sreenivas V, Kapil A, Mathur P, Rasaily R, Deorari AK, Paul VK. Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India. PLoS One 2018; 13:e0180705. [PMID: 29953451 PMCID: PMC6023165 DOI: 10.1371/journal.pone.0180705] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is a paucity of data on the epidemiology of sepsis in outborn neonates being referred to level-3 units in low- and middle-income countries (LMIC). The objective of the present study was to evaluate the prevalence of sepsis and outcomes of outborn neonates with sepsis, and to characterize the pathogen profile and antimicrobial resistance (AMR) patterns of common isolates in them. METHODS In this prospective observational cohort study (2011-2015), a dedicated research team enrolled all neonates admitted to an outborn level-3 neonatal unit and followed them until discharge/death. Sepsis work-up including blood culture(s) was performed upon suspicion of sepsis. All the isolates were identified and tested for antimicrobial susceptibility. Gram-negative pathogens resistant to any three of the five antibiotic classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam) were labeled multi-drug resistant. RESULTS Of the total of 2588 neonates enrolled, culture positive sepsis and total sepsis-i.e. culture positive and/or culture negative sepsis-was diagnosed in 13.1% (95% CI 11.8% to 14.5%) and 54.7% (95% CI 52.8% to 56.6%), respectively. The case fatality rates were 23.4% and 11.0% in culture-positive and total sepsis, respectively. Sepsis accounted for two-thirds of total neonatal deaths (153/235, 63.0%). Bacterial isolates caused about three-fourths (296/401; 73.8%) of the infections. The two common pathogens-Klebsiella pneumoniae (n = 50, 12.5%) and Acinetobacter baumannii (n = 46, 11.5%)-showed high degree of multi-drug resistance (78.0% and 91.3%, respectively) and carbapenem resistance (84.0% and 91.3%, respectively). About a quarter of infections were caused by Candida spp. (n = 91; 22.7%); almost three-fourths (73.7%) of these infections occurred in neonates born at or after 32 weeks' gestation and about two-thirds (62.1%) in those weighing 1500 g or more at birth. CONCLUSIONS In this large outborn cohort, we report high burden of sepsis, high prevalence of systemic fungal infections, and alarming rates of antimicrobial resistance among bacterial pathogens.
Collapse
Affiliation(s)
- Mamta Jajoo
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Suman Chaurasia
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - M. Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Hitender Gautam
- Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Chander Prakash Yadav
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
- National Institute of Malaria Research, New Delhi, India
| | - Kailash C. Aggarwal
- Department of Pediatrics, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Harish Chellani
- Department of Pediatrics, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Siddharth Ramji
- Department of Pediatrics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India
| | - Monorama Deb
- Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Surinder Kumar
- Department of Microbiology, Maulana Azad Medical College and LNJP Hospital, New Delhi, India
| | - Sugandha Arya
- Department of Pediatrics, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, JPNA Trauma Centre, AIIMS, New Delhi, India
| | - Reeta Rasaily
- Division of Reproductive Health & Nutrition, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Ashok K. Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod K. Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
37
|
Singh NP, Choudhury DD, Gupta K, Rai S, Batra P, Manchanda V, Saha R, Kaur I. Predictors for gut colonization of carbapenem-resistant Enterobacteriaceae in neonates in a neonatal intensive care unit. Am J Infect Control 2018; 46:e31-e35. [PMID: 29803234 DOI: 10.1016/j.ajic.2018.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND With the emergence of carbapenem-resistant isolates, the therapeutic alternatives have become limited. Various factors are responsible for carbapenem-resistant Enterobacteriaceae (CRE) gut colonization. This study was conducted to determine predictors for CRE gut colonization in neonates who were hospital delivered and admitted in a neonatal intensive care unit (NICU). METHODS Three rectal swabs were collected from 300 hospital-delivered and NICU-admitted neonates (likely to stay for >3 days). The data collected for the possible risk factors for CRE gut colonization were namely mode of delivery, prolonged rupture of membrane >18 hours, period of gestation, birth weight, meconium-stained liquor, ventilation, intravenous catheter, nasogastric (NG) tube, NG feeding, breastfeeding, katori spoon feeding, top feeding, expressed breastmilk, antibiotics administration, and duration of hospitalization. P < .05 was considered as statistically significant. RESULTS A total of 26 cases of CRE were isolated from 300 neonates. Statistically significant risk factors were found to be NG tube, breastfeeding, NG feeding, top feeding, expressed breastmilk, ventilation, antibiotic administration, and duration of hospitalization. Top feeding and antibiotics administration were identified as 2 independent risk factors by multiple logistic regression. CONCLUSIONS Active surveillance of cultures from hospitalized patients and implementation of preventive efforts can reduce the risk of CRE.
Collapse
|
38
|
Nayyar C, Saksena R, Manchanda V. Prevalence of transfusion-transmitted viral pathogens among health-care workers and risk mitigation programme in a paediatric tertiary care hospital. Indian J Med Microbiol 2018; 35:296-298. [PMID: 28681826 DOI: 10.4103/ijmm.ijmm_15_133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The health-care workers (HCWs) are at an occupational risk of exposure to blood-borne pathogens, mainly, HIV, hepatitis B virus (HBV) and hepatitis C virus. HBV is currently the only blood-borne virus for which a vaccine is available. All health-care institutions must encourage the HCWs to undergo screening for blood-borne pathogens.
Collapse
Affiliation(s)
- Charu Nayyar
- Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Rushika Saksena
- Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Vikas Manchanda
- Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| |
Collapse
|
39
|
Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, Pulcini C, Kahlmeter G, Kluytmans J, Carmeli Y, Ouellette M, Outterson K, Patel J, Cavaleri M, Cox EM, Houchens CR, Grayson ML, Hansen P, Singh N, Theuretzbacher U, Magrini N, Aboderin AO, Al-Abri SS, Awang Jalil N, Benzonana N, Bhattacharya S, Brink AJ, Burkert FR, Cars O, Cornaglia G, Dyar OJ, Friedrich AW, Gales AC, Gandra S, Giske CG, Goff DA, Goossens H, Gottlieb T, Guzman Blanco M, Hryniewicz W, Kattula D, Jinks T, Kanj SS, Kerr L, Kieny MP, Kim YS, Kozlov RS, Labarca J, Laxminarayan R, Leder K, Leibovici L, Levy-Hara G, Littman J, Malhotra-Kumar S, Manchanda V, Moja L, Ndoye B, Pan A, Paterson DL, Paul M, Qiu H, Ramon-Pardo P, Rodríguez-Baño J, Sanguinetti M, Sengupta S, Sharland M, Si-Mehand M, Silver LL, Song W, Steinbakk M, Thomsen J, Thwaites GE, van der Meer JWM, Van Kinh N, Vega S, Villegas MV, Wechsler-Fördös A, Wertheim HFL, Wesangula E, Woodford N, Yilmaz FO, Zorzet A. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. The Lancet Infectious Diseases 2018; 18:318-327. [DOI: 10.1016/s1473-3099(17)30753-3] [Citation(s) in RCA: 2242] [Impact Index Per Article: 373.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/13/2017] [Accepted: 11/01/2017] [Indexed: 12/12/2022]
|
40
|
|
41
|
Narang M, Natarajan R, Shah D, Puri AS, Manchanda V, Kotru M. Celiac Disease in Children with Moderate-to-Severe Iron-deficiency Anemia. Indian Pediatr 2018; 55:31-34. [PMID: 29396932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the proportion of children with moderate to severe iron-deficiency anemia who have associated celiac disease. METHODS This cross-sectional analytical study was conducted among children aged 1 to 12 years of age with moderate-to-severe iron deficiency anemia and control children without anemia. Serum IgA-tissue trans-glutaminase levels were assessed in both cases and controls. All children with positive celiac serology underwent upper gastrointestinal endoscopy and duodenal biopsy; biopsy finding of Marsh grade 3 was considered positive for celiac disease. RESULTS There were 152 anemic children and 152 controls with mean (SD) hemoglobinof 7.7 (1.8) and 12.2 (0.74) g/dL, respectively. 16 (10.5%) cases and 3 (2%) control patients had positive serology for celiac disease [OR (95% CI) 5.33 (1.52-18.67), P=0.007]. Six (3.9%) children with iron-deficiency anemia and none of the controls had biopsy features diagnostic of celiac disease. CONCLUSION In the Northern Indian tertiary-care hospital outpatient setting, Celiac disease was associated with 4% of children presenting with moderate-to-severe anemia.
Collapse
Affiliation(s)
- Manish Narang
- Division of Pediatric Gastroenterology, Department of Pediatrics, University College of Medical Sciences and GTB Hospital; Delhi, India. Correspondence to: Dr Manish Narang, Professor, Department of Pediatrics, UCMS and GTB Hospital, Dilshad Garden, Delhi 110095, India.
| | - Ravikumar Natarajan
- Division of Pediatric Gastroenterology, Department of Pediatrics, University College of Medical Sciences and GTB Hospital; Delhi, India
| | - Dheeraj Shah
- Division of Pediatric Gastroenterology, Department of Pediatrics, University College of Medical Sciences and GTB Hospital; Delhi, India
| | - Amarender Singh Puri
- Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Vikas Manchanda
- Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Mrinalini Kotru
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| |
Collapse
|
42
|
Gupta R, Thakur R, Kushwaha S, Jalan N, Rawat P, Gupta P, Aggarwal A, Gupta M, Manchanda V. Isoniazid and rifampicin heteroresistant Mycobacterium tuberculosis isolated from tuberculous meningitis patients in India. ACTA ACUST UNITED AC 2018; 65:52-56. [DOI: 10.1016/j.ijtb.2017.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/04/2017] [Indexed: 11/25/2022]
|
43
|
Gupta R, Kushwaha S, Thakur R, Jalan N, Rawat P, Gupta P, Aggarwal A, Gupta M, Manchanda V. Predictors of adverse outcome in patients of tuberculous meningitis in a multi-centric study from India. Indian J Tuberc 2017; 64:296-301. [PMID: 28941852 DOI: 10.1016/j.ijtb.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/10/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study aimed to investigate the factors which may predict mortality and neurological disability at one year follow up in patients of tuberculous meningitis (TBM) in India. METHODOLOGY Patients with TBM were prospectively enrolled from July 2012 to September 2014 from four tertiary care hospitals of Delhi. The demographic characteristics, clinical features and laboratory findings were collected and patients were followed up till 1 year. These were analyzed by univariate and multivariate multinomial logistic regression analysis to identify predictors of adverse patient outcome at 1 year follow up. RESULTS Out of 478 patients enrolled, 391 patients could be followed up to 1 year. Sixty-four patients (16.3%) died and 150 patients (39%) survived with one or more neurological disability. Altered sensorium, motor deficit, cranial nerve palsy, seizures, isolation of M. tuberculosis and presence of multi-drug resistance were independently associated with any adverse outcome (death or disability) but by multivariate analysis only motor deficit, altered sensorium and isolation of M. tuberculosis on culture produced a statistically significant model for prediction of patient outcome. CONCLUSION The three-predictor model with motor deficit, altered sensorium and isolation of M. tuberculosis produced a statistically significant model with correct prediction rate of 60.4%. These three variables predicted death with odds ratio of 39.2, 6.7 and 2.1 respectively in comparison to recovery whereas only motor deficit and isolation of M. tuberculosis predicted neurological disability at 1 year with odds ratio of 3.9, 2.4 respectively.
Collapse
Affiliation(s)
- Renu Gupta
- Assistant Professor, Dept. of Microbiology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 95, India.
| | - Suman Kushwaha
- Associate Professor, Dept. of Neurology, IHBAS, Delhi 95, India
| | - Rajeev Thakur
- Prof and Head, Dept. of Microbiology, IHBAS, Delhi 95, India
| | - Nupur Jalan
- Senior Research Fellow, Dept. of Microbiology, IHBAS, Delhi 95, India
| | - Pumanshi Rawat
- Research Assistant, Dept. of Microbiology, IHBAS, Delhi 95, India
| | - Piyush Gupta
- Professor, Dept. of Pediatrics, University College of Medical Sciences, Dilshad Garden, Delhi 95, India
| | - Amitesh Aggarwal
- Asst. Professor, Dept. of Medicine, University College of Medical Sciences, Dilshad Garden, Delhi 95, India
| | - Meena Gupta
- Formerly - Prof and Head, GB Pant Hospital, Delhi, India; Presently - Senior Consultant, Paras Hospital, Gurgaon, Haryana 122002, India
| | - Vikas Manchanda
- Formerly - Assistant Professor, Chacha Nehru Bal Chikitsalya, Delhi, India; Presently - Assistant Professor, Department of Microbiology, Maulana Azad Medical College, Delhi, India
| |
Collapse
|
44
|
Singh N, Manchanda V. Control of multidrug-resistant Gram-negative bacteria in low- and middle-income countries-high impact interventions without much resources. Clin Microbiol Infect 2017; 23:216-218. [PMID: 28274769 DOI: 10.1016/j.cmi.2017.02.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- N Singh
- George Washington University, Children's National Health System, Washington DC, USA.
| | - V Manchanda
- Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
45
|
Wattal C, Javeri Y, Goel N, Dhar D, Saxena S, Singh S, Oberoi JK, Rao BK, Mathur P, Manchanda V, Nangia V, Kapil A, Rattan A, Ghosh S, Singh O, Singh V, Kaur I, Datta S, Gupta SS. Convergence of Minds: For Better Patient Outcome in Intensive Care Unit Infections. Indian J Crit Care Med 2017; 21:154-159. [PMID: 28400686 PMCID: PMC5363104 DOI: 10.4103/ijccm.ijccm_365_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is emergence of resistance to the last-line antibiotics such as carbapenems in Intensive Care Units (ICUs), leaving little effective therapeutic options. Since there are no more newer antibiotics in the armamentarium in the near future, it has become imperative that we harness the interdisciplinary knowledge for the best clinical outcome of the patient. AIMS The aim of the conference was to utilize the synergies between the clinical microbiologists and critical care specialists for better patient care and clinical outcome. MATERIALS AND METHODS A combined continuing medical education program (CME) under the aegis of the Indian Association of Medical Microbiologists - Delhi Chapter and the Indian Society of Critical Care Medicine, Delhi and national capital region was organized to share their expertise on the various topics covering epidemiology, diagnosis, management, and prevention of hospital-acquired infections in ICUs. RESULTS It was agreed that synergy between the clinical microbiologists and critical care medicine is required in understanding the scope of laboratory tests, investigative pathway testing, hospital epidemiology, and optimum use of antibiotics. A consensus on the use of rapid diagnostics such as point-of-care tests, matrix-assisted laser desorption ionization-time of flight mass spectrometry, and molecular tests for the early diagnosis of infectious disease was made. It was agreed that stewardship activities along with hospital infection control practices should be further strengthened for better utilization of the antibiotics. Through this CME, we identified the barriers and actionables for appropriate antimicrobial usage in Indian ICUs. CONCLUSIONS A close coordination between clinical microbiology and critical care medicine opens up avenues to improve antimicrobial prescription practices.
Collapse
Affiliation(s)
- Chand Wattal
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
- Address for correspondence: Dr. Chand Wattal, Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi - 110 060, India. E-mail:
| | - Yash Javeri
- Indian Society of Critical Care Medicine, New Delhi, India
| | - Neeraj Goel
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
| | - Debashish Dhar
- Indian Society of Critical Care Medicine, New Delhi, India
| | - Sonal Saxena
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
| | - Sarman Singh
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
| | | | - B. K. Rao
- Indian Society of Critical Care Medicine, New Delhi, India
| | - Purva Mathur
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
| | - Vikas Manchanda
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
| | - Vivek Nangia
- Indian Society of Critical Care Medicine, New Delhi, India
| | - Arti Kapil
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
| | - Ashok Rattan
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
| | - Supradip Ghosh
- Indian Society of Critical Care Medicine, New Delhi, India
| | - Omender Singh
- Indian Society of Critical Care Medicine, New Delhi, India
| | - Vinod Singh
- Indian Society of Critical Care Medicine, New Delhi, India
| | - Iqbal Kaur
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
| | - Sanghamitra Datta
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
| | - Sharmila Sen Gupta
- Indian Association of Medical Microbiologists – Delhi Chapter, New Delhi, India
| |
Collapse
|
46
|
Saksena R, Nayyar C, Manchanda V. Six-year susceptibility trends and effect of revised Clinical Laboratory Standards Institute breakpoints on ciprofloxacin susceptibility reporting in typhoidal Salmonellae in a tertiary care paediatric hospital in Northern India. Indian J Med Microbiol 2017; 34:520-525. [PMID: 27934835 DOI: 10.4103/0255-0857.195362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The antimicrobial trends over 6 years were studied, and the effect of revised Clinical Laboratory Standards Institute (CLSI) breakpoints (2012) for ciprofloxacin susceptibility reporting in typhoidal Salmonellae was determined. A total of 874 (95.4%) isolates were nalidixic acid-resistant (NAR). Using the CLSI 2011 guidelines (M100-S21), 585 (66.9%) isolates were ciprofloxacin susceptible. The susceptibility reduced to 11 (1.25%) isolates when interpreted using 2012 guidelines (M100-S22). Among the forty nalidixic acid susceptible (NAS) Salmonellae, susceptibility to ciprofloxacin decreased from 37 isolates (M100-S21) to 12 isolates (M100-S22). The 25 cases which appeared resistant with newer guidelines had a minimum inhibitory concentration (MIC) range between 0.125 and 0.5 μg/ml. MIC50 for the third generation cephalosporins varied between 0.125 and 0.5 μg/ml over 6 years whereas MIC90 varied with a broader range of 0.19-1 μg/ml. The gap between NAR and ciprofloxacin-resistant strains identified using 2011 guidelines has been reduced; however, it remains to be seen whether additional NAS, ciprofloxacin-resistant isolates are truly resistant to ciprofloxacin by other mechanisms of resistance.
Collapse
Affiliation(s)
- R Saksena
- Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - C Nayyar
- Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - V Manchanda
- Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya; Department of Microbiology (VM), Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
47
|
Manoharan A, Manchanda V, Balasubramanian S, Lalwani S, Modak M, Bai S, Vijayan A, Shet A, Nagaraj S, Karande S, Nataraj G, Yewale VN, Joshi SA, Iyer RN, Santosham M, Kahn GD, Knoll MD. Invasive pneumococcal disease in children aged younger than 5 years in India: a surveillance study. Lancet Infect Dis 2016; 17:305-312. [PMID: 27956163 DOI: 10.1016/s1473-3099(16)30466-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/07/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Invasive pneumococcal disease continues to be a major cause of morbidity and mortality among children younger than 5 years of age in India. We aimed to provide nationally representative data for the pattern of disease due to Streptococcus pneumoniae, trends in the serotype of invasive pneumococci, and invasive pneumococci antimicrobial resistance patterns, in India. METHODS In this prospective hospital-based and retrospective laboratory-based surveillance study, we prospectively enrolled children aged younger than 5 years with suspected or proven invasive pneumococcal disease from 18 hospitals or institutional centres and retrospectively included laboratory-confirmed pneumococcal isolates from ten sentinel laboratories, together representing 11 states in India. Eligibility criteria were fever higher than 38°C without localising symptoms, clinical presentation of suspected meningitis or pneumonia, and evidence of radiographic pneumonia. We cultured blood and other normally sterile body fluids, reconfirmed and serotyped pneumococcal isolates, and established antimicrobial susceptibility using standard study protocols. FINDINGS Between Jan 1, 2011, and June 30, 2015, we enrolled 4377 patients. Among 361 (8%) patients with culture-proven pneumococcal disease, all clinical data were known for 226 (63%); among these patients, 132 (58%) presented with pneumonia, 78 (35%) presented with meningitis, and 16 (7%) had other clinical conditions. 131 (3%) died overall and 29 (8%) patients with invasive pneumococcal disease died. Serotypes 14 (52 [14%] of 361), 1 (49 [14%]), 5 (37 [10%]), and 19F (33 [9%]) were the most common. Penicillin non-susceptibility occurred in isolates from 29 (8%) patients, co-trimoxazole resistance occurred in 239 (66%), erythromycin resistance occurred in 132 (37%), and chloramphenicol resistance occurred in 33 (9%). We found multidrug resistance in 33 (9%) of 361 patients. INTERPRETATION The proportion of positive blood cultures, number of isolates, geographical representation, and data generated over the 4·5 years of the study are representative of data for most of India. Continued surveillance is warranted as the decision to introduce protein conjugated vaccine in India is made. FUNDING GlaxoSmithKline India.
Collapse
Affiliation(s)
- Anand Manoharan
- Pushpagiri Research Centre, Pushpagiri Institute of Medical Science and Research Centre, Tiruvalla, Kerala, India.
| | - Vikas Manchanda
- Department of Microbiology, Chacha Nehru Bal Chikitsalya, Maulana Azad Medical College, New Delhi, India
| | - Sundaram Balasubramanian
- Department of Pediatrics, Kanchi Kamakoti CHILDS Trust Hospital, and CHILDS Trust Research Foundation, Chennai, Tamil Nadu, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Meera Modak
- Department of Microbiology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Sushama Bai
- Department of Pediatrics, Pushpagiri Institute of Medical Science and Research Centre, Tiruvalla, Kerala, India
| | - Ajith Vijayan
- Department of Microbiology, Pushpagiri Institute of Medical Science and Research Centre, Tiruvalla, Kerala, India
| | - Anita Shet
- Department of Pediatrics, St John's Medical College, Bengaluru, Karnataka, India
| | - Savitha Nagaraj
- Department of Microbiology, St John's Medical College, Bengaluru, Karnataka, India
| | - Sunil Karande
- Department of Pediatrics, King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Gita Nataraj
- Department of Microbiology, King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijay N Yewale
- Dr Yewale Multispecialty Hospital for Children, Vashi, Navi Mumbai, Maharashtra, India
| | - Shrikrishna A Joshi
- Dr Joshi's Central Clinical Microbiology Laboratory, Vashi, Navi Mumbai, Maharashtra, India
| | - Ranganathan N Iyer
- Department of Microbiology and Infectious Diseases, Global Hospitals, Lakdi-Ka Pul, Hyderabad, Telangana, India
| | - Mathuram Santosham
- Department of International Health and International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Geoffrey D Kahn
- Department of International Health and International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria Deloria Knoll
- Department of International Health and International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
48
|
Biswal I, Gaind R, Kumar N, Mohanty S, Manchanda V, Khunger N, V R, Deb M. In vitro antimicrobial susceptibility patterns of Propionibacterium acnes isolated from patients with acne vulgaris. J Infect Dev Ctries 2016; 10:1140-1145. [PMID: 27801379 DOI: 10.3855/jidc.6862] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/19/2015] [Accepted: 06/13/2015] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Propionibacterium acnes has been implicated in the development of acne vulgaris. Rampant use of topical and systemic antibiotics for acne vulgaris has led to resistance due to selective pressure. This study aimed to determine antibiotic resistance of P. acnes. METHODOLOGY A total of 102 samples were collected from acne lesions and cultured onto sheep's blood agar and brain-heart infusion agar supplemented with 5 g/L glucose and 2 mg/L furazolidone) (BHIg) under aerobic and anaerobic conditions. Species identification was done by conventional methods and the VITEK2 Compact system. The isolates were tested for penicillin, erythromycin, clindamycin, ciprofloxacin, nadifloxacin, and tetracycline by E-test, and minimum inhibitory concentration (MIC) of minocycline was determined by agar dilution on BHIg. MIC results were interpreted as per EUCAST (European Committee on Antimicrobial Susceptibility Testing) and CLSI (Clinical Laboratory Standards Institute) guidelines. RESULTS P. acnes was the most common anaerobe (66%) isolated. Resistance rates using EUCAST and CLSI breakpoints were 10.6% and 6.1%, 7.6% and 0%, 7.8% and 0% for erythromycin, clindamycin, and minocycline, respectively. Tetracycline resistance was observed in 9.2% isolates irrespective of the interpretative criteria used. MIC50 and MIC90 values for nadifloxacin (0.25 and 1 µg/mL) were found to be twofold lower than those for ciprofloxacin (0.5 and 1 µg/mL). Similarly, MIC50 and MIC90 values for minocycline (0.125 and 0.5 µg/mL) were also two- to threefold lower than those for tetracycline (0.38 and 1 µg/mL). CONCLUSIONS To the best of our knowledge, this is the first study focusing on P. acnes resistance from India.
Collapse
Affiliation(s)
- Indu Biswal
- Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Mahana S, Tomar R, Agrawal R, Saksena R, Manchanda V, Gupta R. Tuberculous lymphadenitis: Comparison of cytomorphology, Ziehl-Neelsen staining, and rapid mycobacterial culture at a pediatric superspecialty hospital. Cytojournal 2016; 13:17. [PMID: 27563340 PMCID: PMC4977983 DOI: 10.4103/1742-6413.187070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 01/31/2016] [Indexed: 11/05/2022] Open
Abstract
Background: To evaluate and compare the role of Ziehl–Neelsen (ZN) staining and mycobacterial culture in diagnosis of tuberculous lymphadenitis. Materials and Methods: A total of 56 fine needle aspirations (FNAs) from patients who were clinically suspected to have tuberculous lymphadenitis were included. Acid-fast Bacilli detection was attempted by ZN staining on smears as well as culture on Middlebrook 7H9 broth. Percentage positivity of both smears and culture was calculated. Results: Of the 56 cases, 46 showed cytomorphological features consistent with tuberculosis (TB). The most common pattern was only necrosis in 37 cases followed by necrotizing granulomas in 13 cases. ZN-stained smears were positive in 40 cases while culture was positive in only 27 cases. The highest smear and culture positivity was noted in cases with only necrosis. In six cases, diagnosis of TB was made on culture alone since smear was negative in these cases. Conclusion: FNA is a reliable technique for early and accurate diagnosis of tuberculous lymphadenitis in many cases. Mycobacterial culture by newer rapid techniques can assist in bacillary detection in smear-negative cases and also allows for drug sensitivity testing. Hence, culture should be resorted to in such cases.
Collapse
Affiliation(s)
- Sonam Mahana
- Address: Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Reena Tomar
- Address: Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Rawi Agrawal
- Address: Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Rushika Saksena
- Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Ruchika Gupta
- Address: Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| |
Collapse
|
50
|
Rai S, Rani M, Choudhury DD, Singh NP, Gupta A, Manchanda V. Failure to decolonize mupirocin and linezolid resistant MRSA from a patient with necrotizing soft tissue infection. J Infect Public Health 2016; 9:667-9. [PMID: 26837722 DOI: 10.1016/j.jiph.2015.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/24/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022] Open
Abstract
Colonization with methicillin resistant Staphylococcus aureus (MRSA) is considered to be a major risk factor for skin and soft tissue infections. We present a case of a patient suffering from necrotizing soft tissue infection and exposed to multiple antibiotics and developed colonization with linezolid resistant MRSA (LRMRSA). He could not be decolonized despite prolonged conventional or modified MRSA decolonization protocols.
Collapse
Affiliation(s)
- Sumit Rai
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
| | - Mayuri Rani
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Debapriya D Choudhury
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Narendra P Singh
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Arun Gupta
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Vikas Manchanda
- Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| |
Collapse
|