Corynebacterium striatum: an emerging nosocomial pathogen in a case of laryngeal carcinoma

Corynebacterium striatum is an emerging nosocomial pathogen associated with wound infections, pneumonia and meningitis. It is also a multidrug-resistant pathogen causing high morbidity. This is a report of an unusual case of wound infection in a patient with laryngeal carcinoma. Accurate diagnosis of the infection and prompt management helped in a favourable outcome for the patient. This case highlights the role of C. striatum as an important nosocomial pathogen in immunocompromised patients.

Antigen sequence typing of outer membrane protein (fetA) gene of Neisseria meningitidis serogroup A from Delhi & adjoining areas

BACKGROUND & OBJECTIVES

Meningitis caused by Neisseria meningitidis is a fatal disease. Meningococcal meningitis is an endemic disease in Delhi and irregular pattern of outbreaks has been reported in India. All these outbreaks were associated with serogroup A. Detailed molecular characterization of N. meningitidis is required for the management of this fatal disease. In this study, we characterized antigenic diversity of surface exposed outer membrane protein (OMP) FetA antigen of N. meningitidis serogroup A isolates obtained from cases of invasive meningococcal meningitis in Delhi, India.

METHODS

Eight isolates of N. meningitidis were collected from cerebrospinal fluid during October 2008 to May 2011 from occasional cases of meningococcal meningitis. Seven isolates were from outbreaks of meningococcal meningitis in 2005-2006 in Delhi and its adjoining areas. These were subjected to molecular typing of fetA gene, an outer membrane protein gene.

RESULTS

All 15 N. meningitides isolates studied were serogroup A. This surface exposed porin is putatively under immune pressure. Hence as a part of molecular characterization, genotyping was carried out to find out the diversity in outer membrane protein (FetA) gene among the circulating isolates of N. meningitidis. All 15 isolates proved to be of the same existing allele type of FetA variable region (VR) when matched with global database. The allele found was F3-1 for all the isolates.

INTERPRETATION & CONCLUSIONS

There was no diversity reported in the outer membrane protein FetA in the present study and hence this protein appeared to be a stable molecule. More studies on molecular characterization of FetA antigen are required from different serogroups circulating in different parts of the world.

Prevalence of intestinal parasitic infections in HIV-infected individuals and their relationship with immune status

BACKGROUND AND OBJECTIVES

Intestinal parasitic infection is a common entity in patients infected with human immunodeficiency virus (HIV). These infections may lead to fatal complications in the immuno suppressed individuals. The aim of the present study was to determine the prevalence of intestinal parasitic infections in HIV sero-positive patients and their relationship with the immune status of individuals.

MATERIALS AND METHODS

Fecal samples from 100 HIV sero-positive and an equal number of HIV sero-negative individuals were collected and examined for enteric parasites by direct microscopy. CD4 counts were carried out in only HIV sero-positive patients. Prevalence of intestinal parasites in patients with CD4 count<200 cells/μl, 200-499 cells/μl, and ≥500 cells/μl in HIV-infected patients were compared.

RESULTS

Enteric parasites were detected in 59.3% HIV-infected patients with CD4 count<200 cells/μl as compared with 23.5% in patients with CD4 count>200 cells/μl (P<0.01). Prevalence of coccidian parasites was significantly (P<0.01) higher (14%) in HIV sero-positive subjects compared with HIV sero-negative subjects (2%). Isospora belli (25%) was the most common parasite with CD4 count<200 cells/μl, followed by Cryptosporidium parvum (12.5%). Prevalence of intestinal parasitic infections was significantly higher in patients with diarrhea, 73.6% than without diarrhea, 25.9%, (P<0.05). The mean CD4 count of HIV sero-positive patients presenting with diarrhea was significantly (P<0.01) lower (181.26±135.14) than without diarrhea (352.02±204.03).

CONCLUSION

This study emphasizes the need for routine screening of parasites especially in patients with lower CD4 count so as to decrease the morbidity by ensuring the early treatment of the cases.

Evaluation of nucleic acid probe for rapid identification of Mycobacterium tuberculosis complex in extra-pulmonary culture isolates

Patients infected with Non-tuberculous mycobacteria (NTM) usually do not respond to conventional anti-tubercular treatment and are misdiagnosed as infection with multi-drug resistant strains of mycobacterium tuberculosis (M.tb) due to lack of correct species identification, particularly in the developing countries like India. One of the challenges faced by clinicians in the treatment of tuberculosis is the absence of an easy, reliable and rapid identification tool that can accurately differentiate disease caused by M.tb complex from NTM. Keeping this in consideration, the performance of species specific nucleic acid probe i.e. Accuprobe was assessed and compared with conventional niacin production, nitrate reductase assay techniques for identification of M.tb complex in 80 mycobacterial isolates obtained from different extra-pulmonary sites. Accuprobe identified 62 isolates (77.5%) as M. tuberculosis complex and remaining 18 isolates (22.5%) as NTM whereas 64 isolates (80%) were identified as M.tb and rest 16 (20%) were interpreted as NTM by conventional biochemical techniques. The overall agreement between both techniques was 96.9% The sensitivity, specificity, positive predictive value(PPV) and negative predictive value (NPV) shown by accuprobe were 96.9%, 100%, 96.9%, and 88.9% respectively. Thus, accuprobe has showed impressive sensitivity and specificity giving results in < 3 hrs from culture-positive isolates and have sure edge over conventional biochemical methods which are, nonetheless, labour intensive and cumbersome to perform thus delaying prompt mycobacterial identification.

Bacteraemia with pleural effusions complicating typhoid fever caused by high-level ciprofloxacin-resistant Salmonella enterica serotype Typhi

An unusual case of bacteraemia with bilateral pleural effusion caused by Salmonella enterica serotype Typhi in a 10-year-old previously healthy girl is reported. The organism was isolated from pleural fluid aspirate and from blood, and exhibited high-level ciprofloxacin resistance (MIC 16 μg/ml) associated with triple mutations in the QRDRs of the gyrA and parC genes leading to the amino-acid changes Ser83→Phe and Asp87→Asn in gyrA and Ser80→Ile in parC. The patient was successfully treated with parenteral ceftriaxone and intercostal chest tube drainage. The case is notable because of the important issue of antimicrobial resistance in S. Typhi and the therapeutic dilemma faced by clinicians regarding the empirical use of ciprofloxacin and newer fluoroquinolones.

The use of E-test for the drug susceptibility testing of Mycobacterium tuberculosis - a solution or an illusion?

AIM

To evaluate E-test as a tool for rapid determination of drug susceptibility against the conventional LJ method focusing on reliability, expense, ease of standardization and performance of the technique in low resource settings.

MATERIALS AND METHODS

A total of 74 clinical isolates (2004-2005) of Mycobacterium tuberculosis were tested using E-test for susceptibility to streptomycin (STM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB) by E-strip and LJ (LJPM) proportion methods.

RESULTS

The LJPM method, the gold standard, detected resistance against STM in 16.2%, INH in 40.5%, RIF in 18.9% and EMB in 27% cases. In comparison, the resistance values showed by E-test was 66.67% for STM, 57.14% for INH 71.43% for RIF and 80% for EMB. The susceptible correlation was 90.32% for STM, 73.91% for INH, 93.33% for RIF and 59.26% for EMB. E-test correctly identified only eight of the 12 (66.6%) MDR isolates and wrongly identified four isolates which were not MDR. The overall agreement between the two methods was only 48.6%. Resistant isolates showed false positive resistance observed while using E-strip towards all the drugs.

CONCLUSION

E-strips are not quite feasible as a replacement for LJ-proportion method on a large scale due to high risk of cross contamination, laboratory infection, expense associated with it and high false positive resistance observed to all first line drugs. However, the good correlation observed for RIF between the two methods indicates that E-test could contribute to the role in rapid screening of MDR TB isolates as rifampicin mutations are invariably observed in MDR TB isolates.

Concomitant TB and cryptococcosis in HIV-infected patients

Four cases of concomitant tuberculosis and cryptococcosis infection in HIV-positive patients are described. As the HIV pandemic progresses and the proportion of patients with end-stage disease increases, a high suspicion of incidence and unusual forms of infections must always be kept in mind.

Clinical and mycological profile of cryptococcosis in a tertiary care hospital

This study examined the extent of cryptococcosis in clinically diagnosed cases of meningitis in HIV-1 seropositive and apparently immunocompetent patients. One hundred and forty-six samples, obtained from 126 chronic meningitis patients comprised of cerebrospinal fluid (CSF), blood, sputum and urine. The samples were processed by standard microbiological procedures. Cryptococcal isolates were identified by microscopy, cultural characteristics, melanin production on niger seed agar and hydrolysis of urea. The isolates were further speciated on cannavanine glycine bromothymol blue (CGB) media. Cryptococcal antigen detection of CSF samples was performed by latex agglutination test (LAT). Minimum inhibitory concentration (MIC) of amphotericin B for the isolates was also tested. Cryptococcosis was diagnosed in 13 patients (eight HIV-1 seropositive and five apparently immunocompetent). Cryptococcus neoformans var. neoformans was the predominant isolate. Cryptococcal antigen was detected in all, whereas microscopy could detect yeast cells in nine patients. The isolates were sensitive to amphotericin B. CD4 cell counts ranged from 8 to 96/cu mm. The study concludes that all CSF samples with clinical diagnosis of subacute and chronic meningitis should be subjected to tests for detection of Cryptococcus in clinical laboratory irrespective of the immune status.

Development of a multiplexed PCR detection method for Barley and Cereal yellow dwarf viruses, Wheat spindle streak virus, Wheat streak mosaic virus and Soil-borne wheat mosaic virus

Barley and Cereal yellow dwarf viruses (B/CYDVs), Wheat spindle streak mosaic (WSSMV), Soil-borne wheat mosaic virus (SBWMV) and Wheat streak mosaic virus (WSMV) constitute the most economically important group of wheat viruses. In this paper, a multiplex reverse transcription polymerase chain reaction (M-RT-PCR) method was developed for the simultaneous detection and discrimination of eight viruses: five strains of B/CYDVs, WSSMV, SBWMV and WSMV. The protocol uses specific primer sets for each virus producing five distinct fragments 295, 175, 400, 237, and 365 bp, indicating the presence of two strains of BYDVs, -PAV, -MAV, CYDV-RPV and two unassigned Luteoviridae BYDV-SGV and -RMV, respectively. This system also readily detected WSSMV, SBWMV and WSMV specific amplicons at 154, 219 and 193 bp, respectively. The amplification specificity of these primers was tested against a range of field samples from different parts of United States. The protocol also utilizes fluorescently tagged primers that can streamline the detection of each virus through capillary electrophoresis. This study fulfills the need for a rapid and specific wheat virus diagnostic tool that also has the potential for investigating the epidemiology of these viral diseases.

Eumycetoma pedis due to Exophiala jeanselmei

A case of eumycetoma of foot in an 8-year old male child was clinically diagnosed as chronic osteomyelitis and was microbiologically confirmed as eumycetoma. The case is being reported for its uncommon clinical presentation and etiological agent, Exophiala jeanselmei. The patient recovered completely after treatment with ketoconazole.

Use of rK39 for diagnosis of post kala-azar dermal leishmaniasis in Nepal

A recently developed nitrocellulose-based dipstick test, rK39, has been widely used for the diagnosis of kala-azar. In this study, we evaluated its use for the diagnosis of post kala-azar dermal leishmaniasis (PKDL). We also investigated the time taken by patients to develop PKDL after apparent cure of kala-azar (visceral leishmaniasis, VL) and the time taken by patients to come to the hospital after the appearance of symptoms of PKDL. A majority of patients developed the disease within three years after the apparent cure of kala-azar (KA). A majority of patients sought treatment within five years after the onset of PKDL. The amastigotes of Leishmania donovani bodies (LDBs) were demonstrated in 70, 20, and 20% of slit-skin smears (SSS) prepared, respectively, from nodular, papular, and macular forms. The presence of highest density (6+) LDBs in the SSS of 20% of nodular PKDL patients indicated that they may have acted as reservoir in the community. Other reservoirs are not known in Nepal. Only 8% cases were detected by aldehyde test. Although this test is obsolete it is still used in rural parts of Nepal. The dipstick (rK39) was 96% sensitive and 100% specific to diagnose PKDL. Its positive predictive value, negative predictive value, and diagnostic efficacy were 100, 91, and 97% respectively. Due to the advantage of cost compared with the direct agglutination test (DAT), and being easy to use and store in field conditions, rK39 is a good tool to diagnose PKDL in rural situations. All the PKDL patients were cured of the disease after treatment by SAG.

Isospora belli infection in a malnourished child

Isospora belli, a coccidian parasite usually causes a self limiting illness of acute onset with fever, diarrhoea and colicky pain in a normal host. In immunocompromised patients human isosporiasis becomes chronic. We report a case of a malnourished 9 year old female child who presented with complaints of loose stools, nausea, vomiting and weight loss for the past three months. Stool examination revealed immature oocysts of Isospora belli. The patient was successfully treated with TMP-SMX.

Resistance patterns of urinary isolates in a tertiary Indian hospital

BACKGROUND

To analyze the pathogenic organisms recovered from patients with urinary tract infection in a tertiary Indian hospital setting along with determination of the occurrence and antimicrobial sensitivity of uropathogens on a retrospective basis during a period of one year.

METHODS

A total of 5073 urine samples were processed. Urine culture was done using conventional microbiological techniques. Biochemical testing was used to identify the organisms and antibiotic sensitivity was done by the Kirby Bauer method.

RESULTS

A total of 2436 uropathogens were isolated. E coli were seen in 50.7% samples followed by Klebsiella sp (27.6%). Staphylococcus aureus was the commonest Gram-positive isolate (1.5%). Urinary tract infection (UTI) was seen in 70.5% females as compared to 29.5% males. A high recovery of isolates was noted from July to September. Multi drug resistance was commonest with Enterococcus (78.8%) followed by Pseudomonas (65.1%). Drugs, which retained usefulness for Gram-negative isolates, were amikacin, norfloxacin and cefotaxime. For Gram-positive isolates, vancomycin, teicoplanin, lincomycin and Norfloxacin were very effective.

CONCLUSIONS

Our study highlights the changing etiology of UTI and emergence of drug resistance within the Indian subcontinent.

Molecular characterization of ciprofloxacin-resistant Salmonella enterica serovar Typhi and Paratyphi A causing enteric fever in India

OBJECTIVES

To define the genetic characteristics and resistance mechanisms of clinical isolates of Salmonella enterica serovar Typhi (S. Typhi) and S. enterica serovar Paratyphi A (S. Paratyphi A) exhibiting high-level fluoroquinolones resistance.

METHODS

Three S. Typhi and two S. Paratyphi A ciprofloxacin-resistant isolates (MICs > 4 mg/L) were compared with isolates with reduced susceptibility to ciprofloxacin (MICs 0.125-1 mg/L) by PFGE, plasmid analysis, presence of integrons and nucleotide changes in topoisomerase genes.

RESULTS

In S. Typhi and Paratyphi A, a single gyrA mutation (Ser-83-->Phe or Ser-83-->Tyr) was associated with reduced susceptibility to ciprofloxacin (MICs 0.125-1 mg/L); an additional mutation in parC (Ser-80-->Ile, Ser-80-->Arg, Asp-69-->Glu or Gly-78-->Asp) was accompanied by an increase in ciprofloxacin MIC (> or = 0.5 mg/L). Three mutations conferred ciprofloxacin resistance: two in gyrA (Ser-83-->Phe and Asp-87-->Asn or Asp-87-->Gly) and one in parC. This is the first report of parC mutations in S. Typhi. Ciprofloxacin-resistant S. Typhi and S. Paratyphi A differed in their MICs and mutations in gyrA and parC. Moreover S. Typhi harboured a 50 kb transferable plasmid carrying a class 1 integron (dfrA15/aadA1) that confers resistance to co-trimoxazole and tetracycline but not to ciprofloxacin. PFGE revealed undistinguishable XbaI fragment patterns in ciprofloxacin-resistant S. Typhi as well as in S. Paratyphi A isolates and showed that ciprofloxacin-resistant S. Typhi have emerged from a clonally related isolate with reduced susceptibility to ciprofloxacin after sequential acquisition of a second mutation in gyrA.

CONCLUSIONS

To our knowledge this is the first report of molecular characterization of S. Typhi with full resistance to ciprofloxacin. Notably, the presence of a plasmid-borne integron in ciprofloxacin-resistant S. Typhi may lead to a situation of untreatable enteric fever.

Laboratory diagnosis in ulcerative keratitis

AIMS

To identify the common bacterial and fungal isolates from corneal ulcers and to determine the antimicrobial susceptibility patterns of bacterial isolates to commonly used antibiotics at B.P. Koirala Institute of Health Sciences (BPKIHS), eastern Nepal. Culture and direct microscopic correlation and reliability were also compared.

METHODS

All patients with suspected corneal ulceration presenting to the Ophthalmology Department of BPKIHS from 1st August 1998 to 31st July 2001 were evaluated. Corneal scraping was performed and processed for direct microscopy and culture for bacterial and fungal isolates. Bacterial isolates were subjected to antimicrobial susceptibility testing.

RESULTS

Of 447 specimens examined direct microscopy was positive in 216 (48%) specimens. Culture positivity could be correlated with direct microscopy in 179 (83%) of specimens. Growth of etiologic agents was found in 303 (67.8%) samples. Of these 145 (47.8%) had pure fungal growth, 103 (34%) had pure bacterial growth and 55 (18.2%) had mixed fungal and bacterial infection. The commonest fungal pathogen was Aspergillus spp.in 78 (38.4%) followed by Fusarium spp. in 45 (22%). Aureobasidium sp. was isolated in 25 (12.3%) samples. Staphylococcus aureus (93, 56.7%) dominated the scene as the commonest bacterial agent. Streptococcus pneumoniae (33, 20%) was second in the list. Most of the bacterial isolates were sensitive to commonly used antibiotics.

CONCLUSION

This study emphasizes the importance and need of the continued surveillance of the agents and their antimicrobial susceptibility for the prevention and management of corneal ulcers and their complications.

Asymmetric Synthesis and Translational Competence of l-α-(1-Cyclobutenyl)glycine

[reaction: see text] L-alpha-(1-Cyclobutenyl)glycine (1-Cbg) was targeted as a potentially translatable analogue of isoleucine and valine and as a useful building block for peptides. An enantioselective synthesis was executed in which the key step was diastereoselective addition of 1-cyclobutenylmagnesium bromide to the sulfinimine 2b derived from (S)-t-butanesulfinimide and tert-butyl glyoxylate. 1-Cbg was found to substitute efficiently for isoleucine and valine, but not leucine, in the translation of green fluorescent protein in vitro.

Neonatal Septicaemia: A Hospital Based Study in Eastern Nepal

Septicaemia  is  a  major  cause  of  neonatal  morbidity  and  mortality.  Premature  rupture  of  membrane, premature delivery, low birth weight and hospitalisation of the neonate are some of the predisposing factors, which influence the onset of infection and its outcome.   Depending on the time of onset and the causative factors, a wide variety of organisms are implicated in neonatal septicaemia.   The blood culture takes a minimum of 48 hrs to arrive at a definitive diagnosis. A prompt management of such cases along with empirical antibiotic therapy remains the mainstay of management. Hence, knowledge about the organisms prevalent in a particular hospital and their antibiotic susceptibility pattern is an important prerequisite. The study was carried out at the B.P. Koirala institute of health sciences, a tertiary care hospital, in Eastern Nepal for a period of 3-years from 1998 to 2001. Blood samples from 1567 neonates with suspected septicaemia were cultured using standard microbiological technique. 540 (35%) samples were culture positive. Gram- positive bacteria (74%) were more common than Gram-negative bacteria (27%). Staph aureus   (60%) was the most common bacterial isolate. Resistant to ampicillin was seen but most were susceptible to other antimicrobial  including  gentamicin,  amikacin,  cefotaxime,  and  ciprofloxacin.  Positivity  rate  decreased  in the 3rd  year to 25% as against first two years of 41% and 47% respectively, which was, attributed to training and implementation of various measures of infection control practices. Candida spp was not observed during the period of study. It was concluded that a continuous surveillance of the causative agents and their antimicrobial susceptibility pattern is required to control the infection in the hospital neonatal unit.Key Words: Neonatal septicaemia, Organisms, Antimicrobial susceptibility pattern. 

CLINICAL PROFILE AND SEXUAL BEHAVIORS IN PATIENTS OF SEXUALLY TRANSMITTED DISEASES IN A TEACHING HOSPITAL OF EASTERN NEPAL

A hospital based prospective cross sectional study was under taken over one-yearperiod from April 1998 to March 1999 to study the clinical profile and sexual behaviorin sexually transmitted diseases (STDs) patients at Dermatology and Venereology OPDat BPKIHS, Dharan, Nepal. A total of 105 patients giving history suggestive of STDswere studied. These patients were also enquired for their sexual behaviors. Therewere 85 males and 20 females; and the majority (55.2%) was in the age group of 21-30 years. Most of the patients (25.7%) were students followed by housewives (17.2%).service holders (13.3%), businessmen (13.3%), unemployed (9.5%) and fanners(8.5%).. Literates were 80%. Sixty-eight percent males and 90% females were married.Majority of the males contracted infection from CSW (58.8%). Females got theinfection from husbands and friends. More than 50% of male had multiple partnerswhereas in case of females it was only 5%. Homosexual and bisexual were 3.5% and4.7% respectively in males. Unprotected sexual contact was found in 94.1% of malesand 100% of females. Syphilis (30.5%) was the commonest type of STD followed bygonorrhea (14.3%), genital warts (14.3%), chancroid (6.7%), candidiasis (6.7%),herpes genitalis (5.7%), mixed infection (4.7%), donovanosis (2.8%), andLymphogranuloma venereum (0.9%). In homosexual and bisexual, only NGU andsyphilis were seen. STDs constituted 0.97% of all new dermatology patients. In spiteof high proportion of promiscuous sexual behavior, there was only one HIV positivepatient.Key Words: Clinical profile, Sexual behavior, STD patients, Nepal.

AWARENESS AND PRACTICE OF UNIVERSAL PRECAUTIONS BY HEALTH CARE WORKERS IN A TEACHING INSTITUTE

Health Care Workers (HCWs) face a grave risk of acquiring infection including HumanImmunodeficiency Virus (HIV) and Hepatitis B & C during the course of their work.A questionnaire based study was conducted amongst the 154 HCWs working in ateaching hospital to study Acquired Immunodeficiency Syndrome (AIDS) awareness,and to assess the knowledge, attitude, and practice in respect of application of universalprecautions. This study has shown that definite lacunae exist regarding awarenessand practice of universal precautions. Comprehensive in service educationalprogramme for HCWs regarding the implementation of universal precautions isrecommended.

A study of diarrhoea among children in eastern Nepal with special reference to rotavirus

PURPOSE

To examine the incidence of Rotavirus infection in children below five years of age.

METHODS

Faecal samples from 160 children under five years of age with acute gastroenteritis were collected over a period of one year from July 1999 to June 2000. These were studied for the presence of Rotavirus antigen by enzyme immuno assay (EIA).

RESULTS

Rota antigen could be detected in 62 (38.7%) samples. Co-infection with other parasites or bacterial pathogens in presence of Rota antigen was also demonstrated. Forty one (66.4%) children were admitted for hospital care. Forty two samples positive by EIA were further tested by latex agglutination (LA) to consider introducing this test routinely in clinical laboratory. Although a rapid and convenient test, LA failed to demonstrate antigen in 15 (35.6%) of the samples.

CONCLUSIONS

Rotavirus infection of children in Nepal is reported for the first time. EIA was found to be more sensitive than LA for the detection of Rotavirus antigen in faecal samples.

Descriptive Epidemiology of a Gastroenteritis Out Break in Sunsari District, Nepal

Gastroenteritis (GE) outbreak and cholera epidemics continue to be the major publichealth problems in Nepal. Every year during and immediately after the rainy season,outbreak of GE occurs. In the post monsoon period of 1998 also, outbreak of GEoccurred in a wide area covering several districts in terai region. In this paper, severalepidemiological aspects of the current outbreak are being reported. This study wascarried out in sunsari district. The cases of GE brought to district hospital wereinterviewed by a trained health worker to collect information about the episode andpossible source of infection. Stool samples were collected from the patients and testedfor organisms. On the spot visits were made to collect more information. Water sampleswere also collected and tested in Microbiology laboratory, B. P. Koirala Institute ofHealth Sciences (BPKIHS). There were 947 cases of GE. Among them 55.2% werefemales and 44.8% males patients. The age ranged from 7 months to 86 years withmean age of 22.8 years. There were 8 deaths. Maximum number of cases occurred inthe first fornight of October 1998. Due to prior administration of antibiotics, no growthwas seen in 27 samples. However, 4 samples showed growth of Shigella. Vibrio cholerawas isolated from 2 cases. Eight out of thirteen water samples were found to beunsatisfactory for drinking. The contamination of drinking water source andunhygienic habits were the main causes for such outbreaks. Therefore, it is pertinentthat GE outbreaks may be prevented by simply promoting sanitation and hygienicpractices related to handling of drinking water and defecation.

PNEUMOCOCCAL INFECTIONS : REPORT OF A HOSPITAL BASED STUDY

Seventy-one isolates of Streptococcus pneumoniae were obtained from various clinicalspecimens of sixty-six patients. Type of pneumococcal infections varied in differentage groups. Major brunt of the invasive pneumococcal infection was borne by infantsand children. Isolates from infected corneal ulcers were relatively resistant toantimicrobials including penicillin, as compared to those isolated from normallysterile body sites.Key Words: Pneumoccoccal infection, antimicrobial susceptibility, Eastern Nepal.

CRYPTOCOCCAL MENINGITIS IN A NON-AIDS PATIENT

Cryptococcal meningitis that occurred in a patient with no obviouspredisposing factor is reported. The necessity to identify this entity in thecases of chronic meningitis is discussed.ABSTRACTKey Words: Meningitis, Cryptococcus neoformans

Sexual habits and clinico-etiological profile of sexually transmitted diseases in Nepal

A total of 100 patients giving histories suggestive of sexually transmitted disease (STDs) and attending the dermatology OPD at BPKIHS (B.P. Koirala Institute of Health Sciences) in Nepal over a period of one year from 1st July 1999 to 30th June 2000 were included in this study. Out of 10,400 new dermatology cases, a total of 100 cases (0.96%) of STDs were seen. Of these 73 were males, and the majority (53%) were in the age group of 21-30 years. Most of the patients were from Sunsari district (54%). The most common profession (21%) was businessman followed by housewife (19%). The most common age for first sexual contact was 16 to 19 years (45%). Eleven percent had their first sexual contact at the age of 15 or below 15 years. Premarital sexual exposure was recorded in 17% of the unmarried males. There were only 3 homosexuals and 1 bisexual patient. Multiple contacts were recorded in 55% of the patients. The most common source of contact was a commercial sex worker in 34.15%. Condoms were always used by only 7%. The various types of sexually trasmitted diseases (STDs) were syphilis (31%) followed by condylomata acuminata (16%), herpes genitalis (15%), gonorrhoea (9%), and mixed infections (12%). Despite their varied sexual behavior, none of the patients were HIV positive; however, it is always advisable to screen all STD patients for HIV antibody.

Abdominal cocoon: report of a case

The abdominal cocoon is a rare cause of intestinal obstruction most often found in adolescent girls from tropical and subtropical countries. It is characterized by a thick fibrotic sac covering the small bowel partially or completely, the etiology of which is unknown. A correct diagnosis is not often made preoperatively; however, following simple surgical release of the entrapped bowel, these patients usually do well. We report herein our experience of a case of abdominal cocoon with a brief review of the medical literature on this unusual disease entity.