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Thomas S, Duraisamy SK, Ahmed R, Abraham A, Vishwabandhya A, Mathews V, Srivastava A, Samuel P, Kannangai R, Abraham OC, George B, Abraham AM. Early detection, reactivation of cytomegalovirus DNA & immediate early (IE)-mRNA expression in hematopoietic stem cell-transplant patients. Indian J Med Microbiol 2024; 47:100521. [PMID: 38072066 DOI: 10.1016/j.ijmmb.2023.100521] [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: 06/16/2023] [Revised: 11/26/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Human cytomegalovirus (HCMV) reactivation is a major cause of morbidity and mortality among stem cell transplant recipients post-transplantation. AIM HCMV immediate-early messenger RNA (IE-mRNA) was evaluated as marker of post-transplant HCMV reactivation in bone marrow transplant recipients. METHOD ology: An in-house real-time reverse transcriptase PCR targeting IE-mRNA was developed to estimate HCMV mRNA levels post-transplantation. Blood samples collected in K2-EDTA tubes from patients (n = 162) admitted with Department of Clinical Hematology were transported in cold condition for routine HCMV DNA screening. For HCMV IE-mRNA quantification, peripheral blood mononuclear cells (PBMCs) were separated from whole blood and stored in RNA later at -70 °C until testing. Samples were collected weekly once for first 3 weeks post-transplantation and thereafter from week 4-12, samples were collected twice weekly. A total of 2467 samples were collected from 162 study participants. RESULTS Thirty five patients (21.6 %) had post-transplant HCMV reactivation. Twenty five patients with complete follow-up were selected for monitoring HCMV DNA. HCMV IE-mRNA PCR was performed for 15 patients and 7(46.6 %) patients had detectable mRNA levels. HCMV IE-mRNA was detected in all patients with increasing HCMV DNA levels except for one patient in whom IE-mRNA appeared 3 days before HCMV DNA was detected. One patient had detectable HCMV IE-mRNA during declining HCMV DNA level. However the patient showed an increased HCMV DNA one week later, indicating the importance of HCMV mRNA in predicting HCMV replication. CONCLUSION Quantification of HCMV IE-mRNA may be a valuable tool to predict progression of HCMV infection post-transplantation, with further prospective studies needed for validation.
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Affiliation(s)
- Sangeeta Thomas
- Department of Clinical Virology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | | | - Rayaz Ahmed
- Department of Clinical Hematology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Aby Abraham
- Department of Clinical Hematology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Auro Vishwabandhya
- Department of Clinical Hematology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Vikram Mathews
- Department of Clinical Hematology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Alok Srivastava
- Department of Clinical Hematology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Prasanna Samuel
- Department of Biostatistics, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Rajesh Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - O C Abraham
- Department of Medicine, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Biju George
- Department of Clinical Hematology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Asha Mary Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
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Kundu D, Gautam P, Dayanand D, Gunasekaran K, Manesh A, Sebastian M, Abhilash KPP, Zachariah A, George T, Sathyendra S, Hansdak SG, Abraham OC, Iyadurai R, Thangakunam B, Gupta R, Karthik R, Moorthy M, Varghese GM. The role and diagnostic accuracy of serology for COVID-19. BMC Infect Dis 2022; 22:390. [PMID: 35439957 PMCID: PMC9017961 DOI: 10.1186/s12879-022-07361-y] [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: 12/05/2021] [Accepted: 03/25/2022] [Indexed: 01/08/2023] Open
Abstract
Background The role and performance of various serological tests for the diagnosis of COVID-19 are unclear. This study aimed to evaluate the performance of seven commercially available serological assays for SARS-CoV-2 antibodies by testing COVID-19 cases and controls.
Methods Adult patients with fever for > 5 days, admitted to a tertiary-care teaching hospital in South India, were enrolled prospectively between June and December 2020. SARS-CoV-2 RT-PCR confirmed patients were classified as cases, and patients with febrile illness with laboratory-confirmed alternative diagnosis and healthy participants were controls. All participants were tested with SCoV-2 Detect™ IgM ELISA kit and SCoV-2 Detect™ IgG ELISA kit (InBios International, Seattle, USA) (Inbios), SARS-CoV-2 Total and SARS-CoV-2 IgG (Siemens Healthcare Diagnostics Inc., Tarrytown, USA) (Siemens), Roche Elecsys® Anti-SARS-CoV-2 (Roche Diagnostics, Rotkreuz, Switzerland) (Roche), Abbott SARS-CoV-2 IgG (Abbott Diagnostics, IL, USA) (Abbott), and Liaison® SARS-CoV-2 S1/S2 IgG (DiaSorinS.p.A., Saluggia, Italy) (Liaison). The sensitivities, specificities, positive predictive values (PPV), negative predictive values (NPV), and accuracies were compared. Results There were 303 participants: 153 cases and 150 controls. ELISA detecting anti-S protein antibody was more sensitive (88.9% for IgG and 86.3% for IgM) than the CLIAs (82.4% for total antibodies and 76.5–85.6% for IgG). Among CLIAs, Roche IgG was most sensitive (85.6%) followed by Abbott (83%) and Liaison (83%). Abbot had the best PPV (88.8%) and was more specific (89.3%) than Liaison (82%) and Roche (82%). Siemens IgG was less sensitive (76.5%) than Siemens Total (82.4%). The specificity of all the serological assays was modest (75–90%). Antibody test positivity increased with the duration of illness reaching 90% after 10 days of illness. When cases were compared against pre-pandemic controls, the IgG gave excellent specificity (98–100%). For seroprevalence studies, InBios IgG had the best accuracy (90.8%) with 88.9% sensitivity and 97.6% specificity. Conclusion The serological assays are important adjuncts for the diagnosis of COVID-19 in patients with persistent symptoms, especially in the second week of illness. The value of serological diagnostic tests is limited in the first week of illness and they provide additional value in seroprevalence studies. The diagnostic accuracy of the ELISA and CLIA platforms were comparable.
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Affiliation(s)
- Debasree Kundu
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Priyanka Gautam
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Divya Dayanand
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Karthik Gunasekaran
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Merylin Sebastian
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | | | - Anand Zachariah
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tina George
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sowmya Sathyendra
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Samuel G Hansdak
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - O C Abraham
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyadurai
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Richa Gupta
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv Karthik
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Mahesh Moorthy
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India.
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
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Samuel SV, George TK, Gopinathan VR, Abraham OC. Community-acquired fungal pyelonephritis with renal infarction and gangrene of the colon: an uncommon diagnosis. BMJ Case Rep 2022; 15:e241685. [PMID: 35131766 PMCID: PMC8823032 DOI: 10.1136/bcr-2021-241685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Accepted: 12/31/2021] [Indexed: 12/26/2022] Open
Abstract
A 54-year-old male farmer with a history of long-standing uncontrolled type 2 diabetes mellitus (HbA1c 10.8) presented with a 3-week history of fever, intermittent vomiting, malaise and left flank pain for which he was treated with broad-spectrum antibiotics and oral antifungals for Candida isolated from urine culture. CT of the abdomen revealed predominant involvement of the left kidney and retroperitoneal structures. Nephrectomy was performed due to worsening abdominal pain and features of bowel perforation found on imaging. Pus culture from the necrotic kidney grew aseptate fungal hyphae, and the histopathological examination was suggestive of zygomycosis. He received amphotericin B postoperatively, but his condition deteriorated and he succumbed to nosocomial gram-negative septicaemia.
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Affiliation(s)
- Stephen Varghese Samuel
- Geriatric Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Tarun K George
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | | | - O C Abraham
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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George T, J. Sumeir M, Bonela V, Mani T, Mathew J, Abraham OC, Jambugulam M. Economic impact, clinical features and outcomes of hospitalised patients with SLE in India. Indian J Rheumatol 2022. [DOI: 10.4103/injr.injr_30_22] [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: 11/04/2022] Open
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Bharathy KM, John F, Joy A, Nellimala N, Prakash T, John K, Mathuram A, Sathyendra S, Abraham OC, Ramya I, Jayaseelan V, Sudarsanam T. Predictors of in-hospital mortality in patients admitted with congestive Heart failure (HF) in a general medical ward – A case-control study from a tertiary care centre in South India. CHRISMED J Health Res 2021. [DOI: 10.4103/cjhr.cjhr_70_20] [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: 11/04/2022] Open
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Kannan K, John R, Kundu D, Dayanand D, Abhilash KPP, Mathuram AJ, Zachariah A, Sathyendra S, Hansdak SG, Abraham OC, Gunasekaran K, Iyadurai R, Abraham AM, Prakash JAJ, Yesudhason BL, Veeraraghavan B, Kavitha ML, Jose LR, Sumana MN, Saravu K, Varghese GM. Performance of molecular and serologic tests for the diagnosis of scrub typhus. PLoS Negl Trop Dis 2020; 14:e0008747. [PMID: 33180784 PMCID: PMC7660479 DOI: 10.1371/journal.pntd.0008747] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 05/06/2020] [Accepted: 08/25/2020] [Indexed: 01/19/2023] Open
Abstract
Diagnosis of scrub typhus, caused by the bacterium Orientia tsutsugamushi, is challenging because of the overlap of its non-specific symptoms with other infections coupled with the lack of sufficient data on the performance of diagnostic tests. Early diagnosis of scrub typhus is crucial to improve outcomes and this study evaluates the diagnostic performance of various tests. The present study aims at assessing the accuracy of various rapid diagnostic tests, serologic tests, and nucleic acid amplification methods on well-characterized patient samples. Adult patients with acute febrile illness and manifestations suggestive of scrub typhus confirmed by positive PCR in the blood, eschar or tissue were characterized as cases. Patients with acute febrile illness and a confirmed alternate etiology such as culture-confirmed typhoid, smear/PCR positive for malaria, PCR/NS1 antigen positive for dengue, PCR positive for influenza, PCR/MAT positive for leptospirosis, PCR positive for spotted fever were characterized as controls with other infections. The healthy controls consisted of subjects from the same geographic region. We performed the following tests on blood samples for scrub typhus and calculated the sensitivity, specificity, positive predictive value, and negative predictive value: (1) Quantitative real time PCR using 47kDa gene (qPCR); (2) Conventional PCR using 56kDa gene (cPCR); (3) Loop-mediated isothermal amplification assay (LAMP assay); (4) Immunofluorescence assay (IFA); (5) Enzyme-linked immunosorbent assay (ELISA); (6) Weil-Felix test(WF test); and (7) Immunochromatographic Rapid Diagnostic Test (RDT).Among the 316 participants, 158 had confirmed scrub typhus (cases) and 158 were controls. ELISA and RDT detecting Orientia tsutsugamushi specific IgM antibodies had excellent discriminative potential with sensitivities and specificities of 92%, 94% and 92%, 92% respectively. The sensitivity and specificity of IFA were found to be 95% and 74% respectively. IgM serology had a false positivity rate of 8% with other acute febrile illnesses such as dengue, leptospirosis and spotted fever due to the nonspecific binding of the pentavalent IgM. LAMP assay had 91.7% sensitivity and 77.2% specificity while qPCR provided excellent sensitivity (97%) and perfect specificity. In conclusion, ELISA and RDT detecting Orientia tsutsugamushi specific IgM antibodies have excellent sensitivity and specificity while the accuracy of IFA is suboptimal for the diagnosis of scrub typhus. Given its perfect specificity and superior sensitivity, qPCR is preferred for diagnostic confirmation in reference laboratories particularly for diagnosis of early disease with less than 7 days duration. This study provides a comprehensive evaluation of all currently available diagnostic tests for scrub typhus.
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Affiliation(s)
- Kavitha Kannan
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rebecca John
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Debasree Kundu
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Divya Dayanand
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Alice Joan Mathuram
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anand Zachariah
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sowmya Sathyendra
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Samuel G. Hansdak
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - O. C. Abraham
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Karthik Gunasekaran
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyadurai
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Asha M. Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Balaji Veeraraghavan
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - M. L. Kavitha
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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Abdul Kalam S, Carey RA, Antony J, Abraham OC. Acute infectious purpura fulminans: a case series from India. Trop Doct 2020; 50:330-334. [PMID: 32998655 DOI: 10.1177/0049475520930622] [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] [Indexed: 11/16/2022]
Abstract
Acute infectious purpura fulminans is a serious, potentially fatal condition. We present a case series of 11 patients from March 2005 to March 2017, whose clinical symptoms were fever (100%), confusion (63.6%) and headache (55%), and whose common laboratory abnormalities were thrombocytopenia (100%), elevated alkaline phosphatase (70%) and anaemia (63.6%). Three patients (27%) developed gangrene and two presented in shock. Only one grew Neisseria meningitidis in cerebrospinal fluid (CSF) culture and another confirmed by latex agglutination and polymerase chain reaction in CSF. Five others had serology confirmed spotted fever rickettsioses (SFG). All received broad spectrum antibiotics; in 9/11 patients, this included doxycycline or azithromycin. The mean hospital stay was 10.2 days and overall mortality was 18.2%.
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Affiliation(s)
- Sumayya Abdul Kalam
- Postgraduate Registrar, Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ronald Ab Carey
- Professor, Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - John Antony
- Professor, Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - O C Abraham
- Professor, Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, Kar A, Khilnani GC, Krishna B, Kumar P, Mani RK, Rao BK, Singh PK, Singh S, Tiwary P, Wattal C, Govil D, Dixit S, Samavedam S. Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020; 24:222-241. [PMID: 32565632 PMCID: PMC7297240 DOI: 10.5005/jp-journals-10071-23395] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 12/15/2022] Open
Abstract
The global pandemic involving severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) has stretched the limits of science. Ever since it emerged from the Wuhan province in China, it has spread across the world and has been fatal to about 4% of the victims. This position statement of the Indian Society of Critical Care Medicine represents the collective opinion of the experts chosen by the society. HOW TO CITE THIS ARTICLE Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, et al. Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020;24(4):222-241.
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Affiliation(s)
- Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - OC Abraham
- Infectious Disease Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jose Chacko
- Critical Care Medicine, Narayana Hrudyala, Bengaluru, Karnataka, India
| | - Jigeeshu Divatia
- Critical Care and Anesthesia, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Jagiasi
- Department of Critical Care, Reliance Hospital, Navi Mumbai, Maharashtra, India
| | - Arindam Kar
- CK Birla Hospitals; CMRI Institute of Critical Care; Indian Society of Critical Care Medicine; European Society of Intensive Care Medicine
| | - GC Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Hospital, Bengaluru, Karnataka, India
| | - Prashant Kumar
- Department of Anesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - RK Mani
- Critical Care and Pulmonology, Batra Hospital and Medical Research Centre, New Delhi, India
| | - BK Rao
- Department of Critical care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Pawan K Singh
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjeev Singh
- Amrita Institute of Medical Sciences, Ernakulam, Kerala, India; Amrita Hospitals, Faridabad, Haryana, India
| | - Pavan Tiwary
- All India Institute of Medical Sciences, New Delhi, India
| | - Chand Wattal
- Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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George T, Carey RAB, Abraham OC, Sebastian T, Faith MF. Trainee doctors in medicine prefer case-based learning compared to didactic teaching. J Family Med Prim Care 2020; 9:580-584. [PMID: 32318385 PMCID: PMC7113923 DOI: 10.4103/jfmpc.jfmpc_1093_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/02/2019] [Revised: 12/29/2019] [Accepted: 01/09/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Sustaining interest and promoting deep learning is a challenge in any teaching method. The purpose of the study is to find the perception of trainee doctors in Internal Medicine and teaching faculty on the usefulness of case-based learning (CBL) and to compare assessment knowledge outcome with didactic seminars. METHODS AND MATERIALS We developed and conducted a CBL teaching program on eight topics in infectious diseases. First group had CBL and second group had didactic seminars. In step 1, a clinical case was introduced in stages. Learning objectives were formulated and topics were divided among the trainees. At step 2, trainees shared what they had learnt from self-directed learning. Faculty summarized the case and learning points. In the seminar group, trainees made presentations on the given topics. Trainees who had CBL underwent a questionnaire survey. Multiple choice questions-based test was administered for both the groups. RESULTS The trainee doctors and staff overwhelmingly found CBL to be more interesting, stimulating, and useful compared to didactic seminars. There was no statistical difference in the test scores. CONCLUSIONS CBL is a useful and interesting method of learning and should be employed more often in teaching for trainee doctors.
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Affiliation(s)
- Tarun George
- Department of Medicine and Medical Education, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ronald A. B. Carey
- Department of Medicine and Medical Education, Christian Medical College, Vellore, Tamil Nadu, India
| | - O. C. Abraham
- Department of Medicine and Medical Education, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tunny Sebastian
- Department of Medicine and Medical Education, Christian Medical College, Vellore, Tamil Nadu, India
| | - Minnie F. Faith
- Department of Medicine and Medical Education, Christian Medical College, Vellore, Tamil Nadu, India
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10
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Karthik G, Iyadurai R, Ralph R, Prakash V, Abhilash KPP, Sathyendra S, Abraham OC, Truman C, Reginald A. Acute oleander poisoning: A study of clinical profile from a tertiary care center in South India. J Family Med Prim Care 2020; 9:136-140. [PMID: 32110579 PMCID: PMC7014840 DOI: 10.4103/jfmpc.jfmpc_632_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/07/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction: Yellow oleander (Thevetia peruviana), which belongs to the Apocyanaceae family, is a common shrub seen throughout the tropics. All parts of the plant contain high concentrations of cardiac glycosides which are toxic to cardiac muscle and the autonomic nervous system. Here, we describe the clinical profile of patients with oleander poisoning and their outcomes. Methods and Materials: This retrospective study was conducted over a period of 12 months (March 2016 to February 2017). The data was extracted from the inpatient electronic medical records. Adult patients with a diagnosis of acute yellow oleander poisoning were included in the study. Descriptive statistics were obtained for all variables in the study and appropriate statistical tests were employed to ascertain their significance. Results: The study comprised 30 patients aged 30.77 ± 12.31 (mean ± SD) who presented at 12.29 ± 8.48 hours after consumption of yellow oleander. Vomiting (80%) was the most common presenting symptom. Metabolic abnormalities at presentation included hyperchloremia in 22 patients and metabolic acidosis (bicarbonate <24 mmol/L) in 29 patients. Fifteen (50%) patients had abnormal ECG, of which second-degree AV block was the commonest ECG abnormality seen in 4 (13.3%). Fifteen (50%) patients had transvenous temporary pacemaker insertion (TPI). Having a TPI significantly prolonged the duration of hospital stay (OR 1.85, 95% CI 1.06–3.21, P 0.03). The mortality in the cohort was 2 (6.7%). Conclusion: In patients with yellow oleander poisoning, dyselectrolytemia with ECG abnormalities was common. TPI prolonged the duration of hospital stay. Further studies are required to know the indication for and to ascertain the effect of temporary pacing on survival.
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Affiliation(s)
- Gunasekaran Karthik
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyadurai
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ravikar Ralph
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vijay Prakash
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Sowmya Sathyendra
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - O C Abraham
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Catherine Truman
- Department of Pharmacy, Christian Medical College, Vellore, Tamil Nadu, India
| | - Alex Reginald
- Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, Kar A, Khilnani GC, Krishna B, Kumar P, Mani RK, Rao BK, Singh PK, Singh S, Tiwary P, Wattal C, Govil D, Dixit S, Samavedam S. Critical Care for COVID-19 Affected Patients: Updated Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020; 24:S225-S230. [PMID: 33354047 PMCID: PMC7724933 DOI: 10.5005/jp-journals-10071-23621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 12/15/2022] Open
Abstract
The management of coronavirus disease-2019 (COVID-19) is witnessing a change as we learn more about the pathophysiology and the severity of the disease. Several randomized controlled trials (RCTs) and meta-analysis have been published over the last few months. Several interventions and therapies which showed promise in the initial days of the pandemic have subsequently failed to show benefit in well-designed trials. Understanding of the methods of oxygen delivery and ventilation have also evolved over the past few months. The Indian Society of Critical Care Medicine (ISCCM) has reviewed the evidence that has emerged since the publication of its position statement in May and has put together an addendum of updated evidence. How to cite this article: Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, et al. Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020;24(Suppl 5):S225–S230.
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Affiliation(s)
- Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - O C Abraham
- Infectious Disease Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jose Chacko
- Critical Care Medicine, Narayana Hrudyala, Bengaluru, Karnataka, India
| | - Jigeeshu Divatia
- Critical Care and Anesthesia, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Jagiasi
- Department of Critical Care, Reliance Hospital, Navi Mumbai, Maharashtra, India
| | - Arindam Kar
- CK Birla Hospitals, Gurugram, Haryana, India; CMRI Institute of Critical Care, Kolkata, West Bengal, India; Indian Society of Critical Care Medicine; European Society of Intensive Care Medicine
| | - G C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Hospital, Bengaluru, Karnataka, India
| | - Prashant Kumar
- Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - R K Mani
- Critical Care and Pulmonology, Batra Hospital and Medical Research Centre, New Delhi, India
| | - B K Rao
- Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Pawan K Singh
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjeev Singh
- Amrita Institute of Medical Sciences, Ernakulam, Kerala, India; Amrita Hospitals, Faridabad, Haryana, India
| | - Pavan Tiwary
- All India Institute of Medical Sciences, New Delhi, India
| | - Chand Wattal
- Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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Varghese G, John R, Manesh A, Karthik R, Abraham OC. Authors′ response. Indian J Med Res 2020; 152:151-152. [PMID: 32883920 PMCID: PMC7853270 DOI: 10.4103/0971-5916.294037] [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: 11/20/2022] Open
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13
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Sudarsanam T, Ebenezer S, Iyyadurai R, Michael J, Abraham OC, Sudha Jasmine S, P Abhihash KP, Muliyil J. Feasibility and diagnostic benefit of increased cerebrospinal fluid volume and frequency in the diagnosis of tuberculous meningitis. CHRISMED J Health Res 2020. [DOI: 10.4103/cjhr.cjhr_36_19] [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: 11/04/2022] Open
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14
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Kuriakose CK, Mishra AK, Vanjare HA, Raju A, Abraham OC. Visual Disturbance in Patients with Cryptococcal Meningitis: The Road Ahead. J Neurosci Rural Pract 2019; 8:151-152. [PMID: 28149110 PMCID: PMC5225709 DOI: 10.4103/0976-3147.193560] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Cijoy K Kuriakose
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajay Kumar Mishra
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Ancy Raju
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - O C Abraham
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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15
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Veeraraghavan B, Pragasam AK, Bakthavatchalam YD, Anandan S, Ramasubramanian V, Swaminathan S, Gopalakrishnan R, Soman R, Abraham OC, Ohri VC, Walia K. Newer β-Lactam/β-Lactamase inhibitor for multidrug-resistant gram-negative infections: Challenges, implications and surveillance strategy for India. Indian J Med Microbiol 2019; 36:334-343. [PMID: 30429384 DOI: 10.4103/ijmm.ijmm_18_326] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Antimicrobial resistance (AMR) is a major public health concern across the globe, and it is increasing at an alarming rate. Multiple classes of antimicrobials have been used for the treatment of infectious diseases. Rise in the AMR limits its use and hence the prerequisite for the newer agents to combat drug resistance. Among the infections caused by Gram-negative organisms, beta-lactams are one of the most commonly used agents. However, the presence of diverse beta-lactamases hinders its use for therapy. To overcome these enzymes, beta-lactamase inhibitors are being discovered. The aim of this document is to address the burden of AMR in India and interventions to fight against this battle. This document addresses and summarises the following: The current scenario of AMR in India (antimicrobial susceptibility, resistance mechanisms and molecular epidemiology of common pathogens); contentious issues in the use of beta-lactam/beta-lactamase inhibitor as an carbapenem sparing agent; role of newer beta-lactam/beta-lactamase inhibitor agents with its appropriateness to Indian scenario and; the Indian Council of Medical Research interventions to combat drug resistance in terms of surveillance and infection control as a national response to AMR. This document evidences the need for improved national surveillance system and country-specific newer agents to fight against the AMR.
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Affiliation(s)
- Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Agila Kumari Pragasam
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Shalini Anandan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - V Ramasubramanian
- Department of Infectious Diseases, Apollo Hospital, Chennai, Tamil Nadu, India
| | | | - Ram Gopalakrishnan
- Department of Infectious Diseases, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Rajeev Soman
- Department of Infectious Diseases, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - O C Abraham
- Department of Medicine (Unit -1), Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinod C Ohri
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Ramalingam VV, Demosthenes JP, Ghale BC, Rupali P, Varghese GM, Abraham OC, Kannangai R. Frequency of cross-resistance to rilpivirine and etravirine among HIV-1 subtype C infected individuals failing nevirapine/efavirenz based ART regimen. Infect Dis (Lond) 2018; 51:71-74. [PMID: 30371136 DOI: 10.1080/23744235.2018.1510182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/28/2022] Open
Affiliation(s)
- V V Ramalingam
- a Department of Clinical Virology , Christian Medical College , Vellore , India
| | - J P Demosthenes
- a Department of Clinical Virology , Christian Medical College , Vellore , India
| | - B C Ghale
- a Department of Clinical Virology , Christian Medical College , Vellore , India
| | - P Rupali
- b Department of Infectious Diseases , Christian Medical College , Vellore , India
| | - G M Varghese
- b Department of Infectious Diseases , Christian Medical College , Vellore , India
| | - O C Abraham
- c Department of Medicine , Christian Medical College , Vellore , India
| | - R Kannangai
- a Department of Clinical Virology , Christian Medical College , Vellore , India
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Srinidhi BV, Fletcher GJ, Sachidanantham J, Rupali P, Ramalingam VV, Demosthenes JP, Abraham OC, Pulimood SA, Rebekah G, Kannangai R. Effect of Interleukin-28B polymorphism on Interleukin-28 expression and immunological recovery amongst HIV-1-infected individuals following antiretroviral therapy. Indian J Med Microbiol 2017; 35:580-584. [PMID: 29405153 DOI: 10.4103/ijmm.ijmm_17_299] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Type III interferon is well known to have diverse antiviral and immunomodulatory activities. Studies describing the association of interleukin (IL)-28 polymorphisms in treatment-experienced HIV participants are limited. This study was aimed to determine the association of IL-28B gene polymorphisms with immunological recovery in HIV patients on 6-9 months of antiretroviral therapy (ART). METHODS Eighty treatment-naive HIV patients were recruited, of which 48 patients were followed up after 6-9 months of ART. Whole blood samples were collected before and after 6-9 months of ART. CD4, CD8 and CD3 counts were enumerated flow cytometry. IL-28B polymorphisms (rs12979860 and rs8099917) were profiled by polymerase chain reaction (PCR)-restriction fragment length polymorphism. The IL-28 mRNA and plasma HIV-1 viral load were estimated using real-time PCR and plasma IL-28 level by ELISA. RESULTS The CD4, CD4/CD3%, IL-28 mRNA and reversal of CD4/CD8 ratio were significantly increased following 6-9 months of ART (P < 0.01). The rs12979860 CC genotype and rs12979860:rs8099917 (CC: TT) haplotype showed significant association with higher CD4+ T-cell count amongst treatment-naive HIV-infected individuals (P < 0.05). In addition, there was a significant association of rs12979860 CC genotype with increase in CD4/CD3% following 6-9 months of ART. IL-28 mRNA showed correlation with the HIV-1 viral load, and there was a significant increase in the IL-28 mRNA expression following 6-9 months of ART. CONCLUSION Our preliminary findings suggest that IL-28 polymorphisms could influence both immunological recovery and therapeutic response in HIV infection. Hence, functional studies are warranted to understand the mechanistic basis of IL-28-mediated host genetic influence on HIV therapeutic response.
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Affiliation(s)
- B V Srinidhi
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | - G John Fletcher
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Priscilla Rupali
- Department of Medicine and Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - J P Demosthenes
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | - O C Abraham
- Department of Medicine and Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Susanne A Pulimood
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajesh Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
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18
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Korula A, Abraham A, Abubacker FN, Viswabandya A, Lakshmi KM, Abraham OC, Rupali P, Varghese GM, Michael JS, Srivastava A, Mathews V, George B. Invasive fungal infection following chemotherapy for acute myeloid leukaemia-Experience from a developing country. Mycoses 2017; 60:686-691. [PMID: 28736936 DOI: 10.1111/myc.12646] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 12/08/2016] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 12/28/2022]
Abstract
The incidence of invasive fungal infections (IFI) is believed to be higher in patients with acute myeloid leukaemia (AML) undergoing chemotherapy in non-HEPA-filtered rooms. The aim of this study is to review the incidence of IFI in a large cohort of patients with AML treated at a single centre in India. Two hundred and twenty-two patients with AML treated with either induction chemotherapy or salvage chemotherapy between 2008 and 2013 were studied retrospectively. IFI was defined as per the revised EORTC-MSG criteria. Data on type of chemotherapy, prophylactic strategies, engraftment (ANC>500), the presence of IFI and survival were collected. IFI was diagnosed in 86 patients (38.7%) with proven IFI in 12 (5.4%). Use of posaconazole prophylaxis (P=.001) was the only factor associated with reduced incidence of IFI. Survival in patients with proven IFI was lower than those without proven IFI, but not statistically significant (59.4% vs 78.5%; P=.139). There is a high incidence of IFI during induction chemotherapy for acute myeloid leukaemia in developing countries. Posaconazole prophylaxis was associated with a significantly lower incidence of IFI. Optimal yet cost-effective strategies for prevention and early diagnosis of IFI are required to improve survival in patients undergoing chemotherapy for AML.
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Affiliation(s)
- Anu Korula
- Department of Haematology, Christian Medical College, Vellore, India
| | - Aby Abraham
- Department of Haematology, Christian Medical College, Vellore, India
| | | | - Auro Viswabandya
- Department of Haematology, Christian Medical College, Vellore, India
| | - Kavitha M Lakshmi
- Department of Haematology, Christian Medical College, Vellore, India
| | - O C Abraham
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Joy S Michael
- Department of Microbiology and Mycology, Christian Medical College, Vellore, India
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
| | - Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, India
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
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Mathai E, Lloyd G, Cherian T, Abraham OC, Cherian AM. Serological evidence for the continued presence of human rickettsioses in southern India. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.2001.11813652] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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20
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Sachithanandham J, Ramalingam VV, Raja J, Abraham OC, Pulimood SA, Kannangai R. Expression of cytokine-mRNA in peripheral blood mononuclear cell of human immunodeficiency virus-1 subtype C infected individuals with opportunistic viral infections from India (South). Indian J Med Microbiol 2016; 34:76-81. [PMID: 26776123 DOI: 10.4103/0255-0857.174118] [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: 11/04/2022]
Abstract
Human immunodeficiency virus (HIV) disease progression is associated with a marked change in the level of plasma cytokines. The study reported here investigated the level of mRNA expression of different cytokines: Tumour necrosis factor-alpha (TNF-α), interferon (INF)-gamma, interleukin-10 (IL-10) and IL-21 in the peripheral blood mononuclear cell among the antiretroviral therapy naive subtype C HIV-1 infected individuals and normal healthy controls by real time polymerase chain reaction. The mRNA expressions of all the 4 cytokines in HIV-1 infected individuals were significantly higher compared to healthy controls (P value range 0.0004-0.01). The mean level of IL-10, INF-gamma and TNF-α were higher in HIV infected individuals with low CD4 counts (<300 cells/μl). The IL-10 expression showed a significant negative correlation with CD4 counts (r=-0.25, P=0.04) while IL-21 showed a positive correlation with CD4 counts (r=0.26, P=0.03). There was a significant negative correlation between the cytomegalovirus (CMV) viral load and IL-21 expression. Cytokine levels by mRNA detection avoids the inherent problem of measuring plasma level and this study also provide information on the cytokine levels and CD4+ T cell level among HIV-1 subtype C infected individuals with opportunistic viral infections like CMV.
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Affiliation(s)
| | | | | | | | | | - R Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
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21
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Abhilash KPP, Mitra S, Arul JJJ, Raj PM, Balaji V, Kannangai R, Thomas SA, Abraham OC. Changing paradigm of cryptococcal meningitis: an eight-year experience from a tertiary hospital in South India. Indian J Med Microbiol 2016; 33:25-9. [PMID: 25559998 DOI: 10.4103/0255-0857.148372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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
BACKGROUND Cryptococcal meningitis (CM) is a common opportunistic fungal infection causing sub-acute meningitis with the potential for complications and significant mortality. We conducted this study to describe the difference in presentation and outcome between HIV-infected and HIV-uninfected patients. MATERIALS AND METHODS Patients admitted to a tertiary care centre between 2005 and 2013 with confirmed CM were included in the analysis. Details of the clinical presentation, laboratory findings, treatment details, risk factors for infection and outcome were documented and analysed. RESULTS During the study period, 102 (87.2%) cases of CM occurred among HIV infected individuals, whereas 15 (12.8%) occurred among HIV-uninfected patients. HIV-infected patients with CM were younger compared with HIV-uninfected patients (38.2 ± 8.5 years vs. 45 ± 11.5 years; P = 0.07). The median duration of symptoms prior to presentation was shorter in the HIV-infected group (20 ± 32 vs. 30 ± 42; P = 0.03). There was no difference between the cerebrospinal fluid (CSF) lymphocyte counts, CSF protein counts, and CSF sugar levels in both the groups. The diagnostic yield of Cryptococcus was similar with CSF India ink smear (89% vs. 87%), CSF fungal culture (95% vs. 87%), and blood culture (100% vs. 75%) in both the groups. Case fatality rate in the HIV-infected group was 30.6%, whereas there were no deaths in the HIV-uninfected group. CONCLUSION HIV-infected patients with CM have a worse outcome compared to HIV-uninfected patients. The overall trend over 3 decades shows increasingly successful rates of treatment and hence early diagnosis and treatment are of paramount importance.
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Affiliation(s)
- K P P Abhilash
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Varghese GM, Janardhanan J, Mahajan SK, Tariang D, Trowbridge P, Prakash JAJ, David T, Sathendra S, Abraham OC. Molecular epidemiology and genetic diversity of Orientia tsutsugamushi from patients with scrub typhus in 3 regions of India. Emerg Infect Dis 2015; 21:64-9. [PMID: 25530231 PMCID: PMC4285260 DOI: 10.3201/eid2101.140580] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Clarifying local antigenic diversity is critical for development of region-specific vaccines and diagnostics. Scrub typhus, an acute febrile illness that is widespread in the Asia-Pacific region, is caused by the bacterium Orientia tsutsugamushi, which displays high levels of antigenic variation. We conducted an investigation to identify the circulating genotypes of O. tsutsugamushi in 3 scrub typhus–endemic geographic regions of India: South India, Northern India, and Northeast India. Eschar samples collected during September 2010–August 2012 from patients with scrub typhus were subjected to 56-kDa type-specific PCR and sequencing to identify their genotypes. Kato-like strains predominated (61.5%), especially in the South and Northeast, followed by Karp-like strains (27.7%) and Gilliam and Ikeda strains (2.3% each). Neimeng-65 genotype strains were also observed in the Northeast. Clarifying the genotypic diversity of O. tsutsugamushi in India enhances knowledge of the regional diversity among circulating strains and provides potential resources for future region-specific diagnostic studies and vaccine development.
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Sachithanandham J, Kannangai R, Pulimood SA, Desai A, Abraham AM, Abraham OC, Ravi V, Samuel P, Sridharan G. Significance of Epstein-Barr virus (HHV-4) and CMV (HHV-5) infection among subtype-C human immunodeficiency virus-infected individuals. Indian J Med Microbiol 2015; 32:261-9. [PMID: 25008818 DOI: 10.4103/0255-0857.136558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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
PURPOSE Opportunistic viral infections are one of the major causes of morbidity and mortality in HIV infection and their molecular detection in the whole blood could be a useful diagnostic tool. OBJECTIVE The frequency of opportunistic DNA virus infections among HIV-1-infected individuals using multiplex real-time PCR assays was studied. MATERIALS AND METHODS The subjects were in two groups; group 1: Having CD4 counts<100 cells/µl (n=118) and the group 2: counts>350 cells/µl (n=173). Individuals were classified by WHO clinical staging system. Samples from 70 healthy individuals were tested as controls. In-house qualitative multiplex real-time PCR was standardised and whole blood samples from 291 were tested, followed by quantitative real-time PCR for positives. In a proportion of samples genotypes of Epstein-Barr virus (EBV) and CMV were determined. RESULTS The two major viral infections observed were EBV and CMV. The univariate analysis of CMV load showed significant association with cryptococcal meningitis, oral hairy leukoplakia (OHL), CMV retinitis, CD4 counts and WHO staging (P<0.05) while the multivariate analysis showed an association with OHL (P=0.02) and WHO staging (P=0.05). Univariate analysis showed an association of EBV load with CD4 counts and WHO staging (P<0.05) and multivariate analysis had association only with CD4 counts. The CMV load was significantly associated with elevated SGPT and SGOT level (P<0.05) while the EBV had only with SGOT. CONCLUSION This study showed an association of EBV and CMV load with CD4+ T cell counts, WHO staging and elevated liver enzymes. These viral infections can accelerate HIV disease and multiplex real-time PCR can be used for the early detection. Genotype 1 and 2 of EBV and genotype gB1 and gB2 of CMV were the prevalent in the HIV-1 subtype C-infected south Indians.
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Affiliation(s)
| | - R Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
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24
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Carey RAB, Rupali P, Abraham OC, Kattula D. Does first line antiretroviral therapy increase the prevalence of cardiovascular risk factors in Indian patients?: A cross sectional study. J Postgrad Med 2014; 59:258-62. [PMID: 24346381 DOI: 10.4103/0022-3859.123145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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] Open
Abstract
CONTEXT Antiretroviral therapy (ART) is associated with a myriad of metabolic complications which are potential cardiovascular risk factors. Early detection of these risk factors could help in alleviating morbidity and mortality in human immunodeficiency virus (HIV) infected patients on ART. AIMS To study the prevalence of cardiovascular risk factors in patients on a combination of nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs (NNRTIs) - the standard combination first line ART regimen used in tertiary referral center. SETTINGS AND DESIGN The prevalence of cardiovascular risk factors in HIV infected subjects with stage 1t disease on standard first line ART for at least 1 year, HIV infected subjects with stage 1 disease and not on ART and HIV negative subjects was assessed. The study was a cross-sectional study design. MATERIALS AND METHODS Basic demographic data was collected and patients were examined for anthropometric data and blood was collected for analysis of blood glucose, serum lipids, and fasting insulin levels. STATISTICAL ANALYSIS Chi-square test was used to calculate significance. Statistical Package for Social Sciences (SPSS) software version 16.0 was used for data analysis. RESULTS The prevalence of hypercholesterolemia and hypertriglyceridemia was higher in the patients on ART when compared to patients not on ART (P<0.001). There was no difference in the prevalence of abnormal glycemic status, obesity, abdominal obesity, insulin resistance, and hyperinsulinemia between patients on ART and those not on ART. CONCLUSIONS First line ART is associated with increased prevalence of dyslipidemia. Early detection and treatment of dyslipidemia should help in reducing the cardiovascular morbidity in patients on ART.
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Affiliation(s)
- R A B Carey
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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25
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Gopinath KG, Chrispal A, Boorugu H, Chandy S, Prakash JJ, Abraham AM, Abraham OC, Thomas K. Clinico-epidemiological profile of seven adults with spotted fever from a tertiary care hospital in South India. Trop Doct 2013; 44:89-91. [PMID: 24334402 DOI: 10.1177/0049475513515478] [Citation(s) in RCA: 3] [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] [Indexed: 11/16/2022]
Abstract
Spotted fever (SF), a tick-borne rickettsial infection, is being increasingly reported from mainly northern Indian states. A lack of awareness and confirmatory laboratory tests underestimate the incidence of this infection which, in India, is predominantly seen during the rainy season. Many patients diagnosed with viral exanthematous illnesses may be suffering from SF, which is treatable if detected early. There is very little data on SF in adults in southern India. We present seven patients with SF treated between January 2007 and January 2008 in a tertiary care hospital in South India. All presented during the rainy season, with rash (100%) and generalized oedema (71%) being the most common features. There was one death due to type I respiratory failure. Renal failure, shock, aseptic meningitis and hepatitis were other significant abnormalities detected in these patients. Clinicians need to be aware of SF and suspect it in appropriate patients.
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Affiliation(s)
- Kango Gopal Gopinath
- Associate Professor of Geriatrics, Department of Geriatrics and Internal Medicine Unit 3, Christian Medical College, Vellore, India
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Abstract
Scrub typhus is an emerging infectious disease in India. Among its protean clinical manifestations, central nervous system involvement is common. In this prospective observational study, altered sensorium, headache, seizures and aseptic meningitis were found to be common central nervous system manifestations. Prompt treatment with doxycycline reduces morbidity and mortality.
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Affiliation(s)
- Harikishan Boorugu
- Assistant Professor, Department of Internal Medicine, Christian Medical College, Vellore, India
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Ghafur A, Mathai D, Muruganathan A, Jayalal JA, Kant R, Chaudhary D, Prabhash K, Abraham OC, Gopalakrishnan R, Ramasubramanian V, Shah SN, Pardeshi R, Huilgol A, Kapil A, Gill JPS, Singh S, Rissam HS, Todi S, Hegde BM, Parikh P. The Chennai declaration: A roadmap to tackle the challenge of antimicrobial resistance. Indian J Cancer 2013; 50:71-3. [DOI: 10.4103/0019-509x.104065] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Stall N, Rubin T, Michael JS, Mathai D, Abraham OC, Mathews P, Thomas K, John M, Daley P. Does solid culture for tuberculosis influence clinical decision making in India? Int J Tuberc Lung Dis 2011; 15:641-6. [PMID: 21756515 DOI: 10.5588/ijtld.10.0195] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Medical units at an academic tertiary referral hospital in Southern India. OBJECTIVE To investigate the impact of solid culture on Löwenstein-Jensen medium on clinical decision making. DESIGN In a retrospective review of 150 culture-positive and 150 culture-negative consecutively sampled tuberculosis (TB) suspects, treatment decisions were analysed at presentation, after the availability of culture detection results and after the availability of drug susceptibility testing (DST) culture results. RESULTS A total of 124 (82.7%) culture-positive patients and 35 (23.3%) culture-negative patients started anti-tuberculosis treatment prior to receiving their culture results; 101 patients (33.7%) returned for their results; two (1.3%) initiated treatment based on positive culture and no culture-negative patients discontinued treatment. DST was performed on 119 (79.3%) positive cultures: 30 (25.2%) showed any resistance, eight (6.7%) showed multidrug resistance and one (0.84%) showed extensively drug-resistant TB. Twenty-eight patients (23.5%) returned for their DST results. Based on DST, treatment was modified in four patients (3.4%). CONCLUSION Using solid culture, 150 cultures need to be tested for one treatment modification and 30 for DST. The cost of the widespread application of culture will need to be balanced against its impact on treatment decisions in India.
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Affiliation(s)
- N Stall
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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Chordia P, Christopher S, Abraham OC, Muliyil J, Kang G, Ajjampur SSR. Risk factors for acquiring Strongyloides stercoralis infection among patients attending a tertiary hospital in south India. Indian J Med Microbiol 2011; 29:147-51. [DOI: 10.4103/0255-0857.81797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abhilash KPP, Veeraraghavan B, Abraham OC. Epidemiology and outcome of bacteremia caused by extended spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella spp. in a tertiary care teaching hospital in south India. J Assoc Physicians India 2010; 58 Suppl:13-17. [PMID: 21563608] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Production of extended spectrum beta-lactamase (ESBL) is one of the most important resistance mechanisms that hamper the antimicrobial treatment of infections caused by Enterobacteriaceae. Therefore, it is imperative to quantify the problem, and reinforce guidelines promoting appropriate antibiotic use. OBJECTIVES To determine the prevalence, risk factors and the outcome of antibiotic treatment among hospitalized adults with bacteremia caused by ESBL producing strains of E. coli and Klebsiella spp. STUDY DESIGN Prospective cohort study METHODS Sequentially encountered patients bacteremias due to E. coli or Klebsiella spp. were prospectively followed up for 14 days from the diagnosis of bacteremia. RESULTS Among the 131 bacteremic patients (62.6% nosocomially acquired), ESBL production was detected in 73.28% of the isolates of E. coli and Klebsiella spp. ESBL production was more common among isolates from patients with nosocomial infections than isolates from community acquired infections (85.37% versus 53.06%; p = < 0.001). Prior use of 3rd or 4th generation cephalosporins was associated with an increased risk of ESBL production (p = 0.017). A high degree resistance to multiple classes of antibiotics was noted. Carbapenems were the most active antibiotics in-vitro (imipenem susceptibility 99.2%). The commonest source of bacteremia was the urinary tract (45.04%). The 14-day mortality rate was 23.6%. There was no significant difference was seen in the mortality rate between E. coli and Klebsiella spp. infections, ESBL-producing and non-ESBL-producing strains, nosocomial and community acquired infections and among those treated with inappropriate antibiotics initially. CONCLUSIONS This study shows a very high ESBL production and resistance to multiple classes of antibiotics, even among patients with community acquired infections caused by Enterobacteriaceae. The empiric use of 3rd and 4th generation cephalosporins should be curtailed, as cephalosporin use was associated with an increased risk of ESBL production. In view of their excellent in-vitro activity, carbapenems should be the initial empiric choice for serious life threatening infections caused by ESBL producing Enterobacteriaceae, with prompt de-escalation when culture and susceptibility results become available.
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Affiliation(s)
- K P P Abhilash
- Department of Medicine Unit 1 & Infectious Diseases, Christian Medical College, Vellore
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Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JAJ, Thomas EM, Abraham AM, Abraham OC, Thomas K. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors - an experience from a tertiary care hospital in South India. Trop Doct 2010; 40:230-4. [PMID: 20870680 DOI: 10.1258/td.2010.100132] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Local prevalences of individual diseases influence the prioritization of the differential diagnoses of a clinical syndrome of acute undifferentiated febrile illness (AFI). This study was conducted in order to delineate the aetiology of AFI that present to a tertiary hospital in southern India and to describe disease-specific clinical profiles. An 1-year prospective, observational study was conducted in adults (age >16 years) who presented with an undifferentiated febrile illness of duration 5-21 days, requiring hospitalization. Blood cultures, malarial parasites and febrile serology (acute and convalescent), in addition to clinical evaluations and basic investigations were performed. Comparisons were made between each disease and the other AFIs. A total of 398 AFI patients were diagnosed with: scrub typhus (47.5%); malaria (17.1%); enteric fever (8.0%); dengue (7.0%); leptospirosis (3.0%); spotted fever rickettsiosis (1.8%); Hantavirus (0.3%); alternate diagnosis (7.3%); and unclear diagnoses (8.0%). Leucocytosis, acute respiratory distress syndrome, aseptic meningitis, mild serum transaminase elevation and hypoalbuminaemia were independently associated with scrub typhus. Normal leukocyte counts, moderate to severe thrombocytopenia, renal failure, splenomegaly and hyperbilirubinaemia with mildly elevated serum transaminases were associated with malaria. Rash, overt bleeding manifestations, normal to low leukocyte counts, moderate to severe thrombocytopenia and significantly elevated hepatic transaminases were associated with dengue. Enteric fever was associated with loose stools, normal to low leukocyte counts and normal platelet counts. It is imperative to maintain a sound epidemiological database of AFIs so that evidence-based diagnostic criteria and treatment guidelines can be developed.
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Affiliation(s)
- Anugrah Chrispal
- Department of Medicine Unit 2, Christian Medical College, Vellore, Tamil Nadu, India.
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Chrispal A, Boorugu H, Gopinath KG, Prakash JAJ, Chandy S, Abraham OC, Abraham AM, Thomas K. Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. Trop Doct 2010; 40:129-33. [PMID: 20360426 DOI: 10.1258/td.2010.090452] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Scrub typhus is an important cause of acute undifferentiated febrile illnesses in the Indian subcontinent. Delay in diagnosis and in the initiation of appropriate treatment can result in severe complications such as acute respiratory distress syndrome (ARDS), septic shock and multisystem organ failure culminating in death. We conducted a prospective, observational study to delineate the clinical profile and predictors of mortality in scrub typhus in adults admitted to the medical wards of a tertiary care, referral hospital in South India over a one-year period. The case fatality rate in this study was 12.2%. Metabolic acidosis (odds ratio [OR] 6.1), ARDS (OR 3.6), altered sensorium (OR 3.6) and shock (OR 3.1) were independent predictors of mortality. It appears that scrub typhus has four possible overlapping clinical presentations: mild disease; respiratory predominant disease; central nervous system predominant disease (meningoencephalitis); or sepsis syndrome. Given the telltale presence of an eschar (evident in 45.5%), the characteristic clinical profile and the dramatic therapeutic response to a cheap, yet effective, drug such as doxycycline, medical practitioners in the region should have ample opportunity to reach an early diagnosis and initiate treatment which could, potentially, reduce the mortality and morbidity associated with scrub typhus.
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Affiliation(s)
- Anugrah Chrispal
- Department of Medicine Unit 2, Christian Medical College, Vellore 632004, Tamil Nadu, India.
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Kandathil AJ, Kannangai R, Abraham OC, Rupali P, Pulimood SA, Verghese VP, Grant P, Pillay D, Sridharan G. The frequency of HIV-I drug resistance mutations among treatment-naive individuals at a tertiary care centre in south India. Int J STD AIDS 2009; 20:522-6. [PMID: 19625581 DOI: 10.1258/ijsa.2008.008403] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Antiretroviral treatment (ART) use in India requires information on baseline drug resistance mutations and polymorphisms in the protease (Pr) and reverse transcriptase (RT) genes of HIV-1 strains from treatment-naïve individuals. We report resistance predictor mutations and polymorphisms in the Pr and the RT sequence of non-clade B HIV-1 strains from ART naïve individuals. The genotypic resistance assay was done on 93 treatment-naïve individuals. The sequences were analysed by Stanford HIV drug resistance data for genotypic drug resistance analysis and REGA HIV-1 subtyping tool. Phylogenetic tree was generated with MEGA 4 for quality control. Ninety-two strains belonged to clade C and one to clade A (A1). Amino acid substitutions were seen at positions associated with drug resistance in Pr gene--10, 24, 74 (each 3%) and position 82 (11%). Substitutions were seen at positions 41 (1%), 100 (1%), 101 (6%), 103 (2%), 179 (6%) and 181 (1%) of the RT sequence known to confer drug resistance in clade B. Polymorphisms in HIV-1 pol gene among treatment-naïve individuals were similar when compared with previous data. One strain each had Y181C substitution, T74S and E35G substitutions in the Pr and one had A98G, K101R and L210FL substitutions in RT.
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Affiliation(s)
- A J Kandathil
- Department of Clinical Virology, Christian Medical College, Vellore, India
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Sachithanandham J, Ramamurthy M, Kannangai R, Daniel HD, Abraham OC, Rupali P, Pulimood SA, Abraham AM, Sridharan G. Detection of opportunistic DNA viral infections by multiplex PCR among HIV infected individuals receiving care at a tertiary care hospital in South India. Indian J Med Microbiol 2009; 27:210-6. [PMID: 19584500 DOI: 10.4103/0255-0857.53202] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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
PURPOSE Opportunistic viral infections cause increased morbidity and mortality among human immunodeficiency virus (HIV) infected individuals, especially those who are not on antiretroviral treatment. Early diagnosis of these opportunistic viruses will be able to reduce the risk of disease progression with appropriate intervention. MATERIALS AND METHODS Multiplex PCR was attempted to detect the opportunistic herpes viruses (HSV-1, HSV-2, VZV, EBV, and CMV), adenovirus and polyoma viruses (JC and BK) in three cocktails of PCR reactions. Subsequently, all the viruses detected were quantitated by testing using monoplex real time PCR. Whole blood samples collected between 2006 and 2007 from 68 treatment naïve HIV-1 infected and 30 normal healthy individuals were tested for these eight viruses. Among the 68 HIV-1 infected individuals 35 had CD4+ T cell count less than or equal to 200 while the other 33 had greater than 200 CD4+ T cells. RESULTS Among the 68 HIV-1 infected individuals, 49 (72%) were positive for EBV, 5 (7%) samples were positive for CMV. All the five CMV positive individuals had CD4+ T cell count of less than or equal to 200 cells/microL. The mean EBV load among the individuals with a CD4+ T cells of less than or equal to 200 cells/microL was 3.88 log(10) while among those with greater than 200 CD4+ T cells it was 3.75 log(10) . The mean CMV load was 6.98 log(10). Three samples were positive for both CMV & EBV. None of the samples was positive for HSV-1, HSV-2, VZV, Adenovirus, JC and BK viruses. CONCLUSIONS In our study, multiplex PCR based detection system was found useful in detecting opportunistic viruses in HIV infected individuals. Though EBV is the most prevalent opportunistic viral infection among HIV infected individuals, there was no significant association between EBV load, CD4+ T cell counts and HIV-1 virus load. CMV was seen in HIV infected individuals with low CD4+ T cell counts (less than 200 cells/microL).
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Affiliation(s)
- J Sachithanandham
- Department of Clinical Virology, Christian Medical College, Vellore, India
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Kandathil AJ, Kannangai R, Verghese VP, Pulimood SA, Rupali P, Sridharan G, Grant P, Pillay D, Abraham OC. Drug resistant mutations detected by genotypic drug resistance testing in patients failing therapy in clade C HIV-1 infected individuals from India. Indian J Med Microbiol 2009; 27:231-6. [PMID: 19584504 DOI: 10.4103/0255-0857.53205] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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
PURPOSE There has been an increase in the number of individuals administered antiretroviral therapy (ART) in India but treatment outcome is hampered by increasing development of drug resistance. Previous reports from India have shown M184V as the commonest mutation in treated individuals. However, there is no evidence for any protease mutations in these reports. This study was done to observe the common/unique mutational patterns observed in reverse transcriptase (RT) and protease (Pr) genes of clade C HIV-1 strains from individuals showing treatment failure in India. MATERIALS AND METHODS The assay was done by sequencing the Pr and RT genes of the HIV-1 strains from 18 individuals failing ART. Analysis was carried out using Stanford HIV drug resistance database (SHDB). The sequences were also submitted to the calibrated population resistance tool of SHDB and Rega HIV-1 sub typing tool. Phylogenetic analysis and quality control were performed with Mega 4. RESULTS Among the 20 strains, 19 showed resistance to both nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), one strain to NNRTIs and five strains showed protease inhibitors (PI) resistance and 3-class resistance. The most common mutation conferring NRTI resistance was M184V (90%) while K103N (45%) was the most common mutation conferring NNRTI resistance. The M46I mutation was seen in 20% of the Pr sequences. CONCLUSION Resistance testing to check the prevalence of drug resistance mutations that arise following failure of the first line regimen to establish guidelines for second line regimens in India is a must. Studies are needed to confirm if mutation patterns that arise among clade C following failure of ART are the same as for clade B strains.
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Affiliation(s)
- A J Kandathil
- Department of Clinical Virology, Christian Medical College, Vellore, India
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Sivadasan A, Abraham OC, Rupali P, Pulimood SA, Rajan J, Rajkumar S, Zachariah A, Kannangai R, Kandathil AJ, Sridharan G, Mathai D. High rates of regimen change due to drug toxicity among a cohort of South Indian adults with HIV infection initiated on generic, first-line antiretroviral treatment. J Assoc Physicians India 2009; 57:384-388. [PMID: 19634284] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To determine the rates, reasons and predictors of treatment change of the initial antiretroviral treatment (ART) regimen in HIV-infected south Indian adults. METHODS In this prospective cohort study, ART-naive adults initiated on generic, fixed dose combination ART as per the National AIDS Control Organization guidelines were followed up at an academic medical center. Treatment change was defined as any event which necessitated a change in or discontinuation of the initial ART regimen. RESULTS Two hundred and thirty persons with HIV infection (males 74.8% and median age 37 years) were followed up for median duration of 48 weeks. The majority (98.7%) had acquired HIV infection through the heterosexual route. Most (70.4%) had advanced IV infection (WHO clinical stage 3 or 4) and 78% had CD4+ T-lymphocyte counts below 200 cells/microL. The initial ART regimens used were: Lamivudine (3TC) with Stavudine (d4T) (in 76%) or Azidothymidine (AZT) and Nevirapine (NVP) (in 86%) or Efavirenz (EFV). The cumulative incidence of treatment change was 39.6% (91 patients). Drug toxicity (WHO grade 3 or 4) was the reason for treatment change among 62 (27%) (incidence rate 35.9/100 person-years). The most common toxicities were attributable to the thymidine analogue nucleoside reverse transcriptase inhibitors (NRTIs), d4T and AZT [lactic acidosis (8.7%), anemia (7%) and peripheral neuropathy (5.2%)]. The other toxicities were rash (3.9%) and hepatitis (1.3%) due to NVP. The mortality (4.6/100 person-years) and disease progression rates (4.1/100 person-years) were low. CONCLUSIONS The ART regimens used in this study were effective in decreasing disease progression and death. However, they were associated with high rates of drug toxicities, particularly those attributable to thymidine analogue NRTI. As efforts are made to improve access to ART, treatment regimens chosen should not only be potent, but also safe.
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Mitra S, Karthik R, Balaji V, George IA, Kapil A, Abraham OC. Quinolone-resistant Salmonella enterica Serovar typhi presenting as acute fulminant hepatitis. J Assoc Physicians India 2009; 57:338-339. [PMID: 19702041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- S Mitra
- Department of Medicine Unit 1 and Infectious Diseases, Christian Medical College and Hospital, Vellore
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Ramalingam S, Kannangai R, Abraham OC, Subramanian S, Rupali P, Pulimood SA, Jesudason MV, Sridharan G. Investigation of apoptotic markers among human immunodeficiency virus (HIV-1) infected individuals. Indian J Med Res 2008; 128:728-733. [PMID: 19246796] [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: 05/27/2023] Open
Abstract
BACKGROUND & OBJECTIVES Apoptosis causes a decline in the counts of uninfected bystander CD4+ T cells in HIV infection. The rate of disease progression of HIV infection is considered to be faster in the developing countries. The present study was carried out to investigate certain markers for apoptosis in immunopathogensis of disease in HIV infected south Indian population. METHODS Soluble Fas (sFas) antigen and Fas ligand levels in plasma samples from 39 antiretroviral treatment naïve patients was estimated and compared with T cell subsets and HIV-1 viral load. RESULTS The mean sFas antigen levels among controls and the CDC A, B and C clinical stages were 2.77, 3.08, 3.26 and 3.28 ng /ml respectively, higher though not significantly among HIV-1 infected individuals compared to controls. The mean sFas ligand levels in CDC A, B and C stages were 0.138, 0.125 and 0.117 ng/ml respectively were higher (P<0.001) than controls (0.073 ng/ml) and positively correlated with total lymphocyte % (r=0.43, P =0.007). sFas antigen levels were negatively correlated with total WBC count (r=-0.34, P=0.04), CD4% (r=-0.4, P=0.01) and CD4:CD8 ratio (r=-0.37, P=0.02). There was an increase in plasma levels of sFas antigen and Fas ligand over time in asymptomatics. INTERPRETATION & CONCLUSION The high levels of sFas antigen and Fas ligand seen in HIV infected individuals suggest increased activation and apoptosis of T cells, due to constant stimulation of the immune system by inter-current infections of HIV infected individuals in south India.
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Affiliation(s)
- Sandeep Ramalingam
- Department of Clinical Virology, Christian Medical College, Vellore, India
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Balaji V, Rajiv K, Abraham OC. Burkholderia pseudomallei recovered in an HIV-positive individual. Indian J Med Sci 2008; 62:456-458. [PMID: 19265236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Rupali P, Evangelynn SB, Abraham OC, Korula RJ, Shukla V, Thankachen R, Ponniah M, Subramanian S, Jeyaseelan V, Mathai D. Granulomatous hepatitis following open heart surgery with cardiopulmonary bypass. Natl Med J India 2008; 21:222-224. [PMID: 19320320] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) initiates an inflammatory cascade, predisposing the patient to a number of infections. The stress of surgery and anaesthesia further expose the patient to a variety of non-infectious complications. We report a group of patients who developed granulomatous disease after open heart surgery. METHODS We retrospectively analysed a subset of patients who developed a syndrome of fever, jaundice and hepatomegaly after open heart surgery. We recruited age- and sex-matched controls who underwent open heart surgery during the same period (July 2002-July 2004). Details of demographic profiles, diagnostic evaluation and drug treatment were noted and compared between the two groups using the SPSS software. RESULTS Five patients were identified to have the specific syndrome of high grade intermittent fever with jaundice and hepatomegaly with investigations revealing an intrahepatic cholestasis. A detailed evaluation revealed granulomas in tissue specimens of the bone marrow and/or liver in these patients. An extensive evaluation for an alternative aetiological agent was non-contributory. CONCLUSION We found granulomatous hepatitis in 5 patients following open heart surgery and they were given conventional antituberculous therapy to which they responded. It is possible that in these patients, tuberculosis was re-activated from a dormant focus due to a period of transient immunodeficiency caused by an extracorporeal circulation.
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Affiliation(s)
- P Rupali
- Christian Medical College, Vellore 632004, Tamil Nadu, India.
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Kandathil AJ, Kannangai R, Abraham OC, Sudarsanam TD, Pulimood SA, Sridharan G. Genotypic resistance profile of HIV-1 protease gene: a preliminary report from Vellore, south India. Indian J Med Microbiol 2008; 26:151-4. [PMID: 18445952 DOI: 10.4103/0255-0857.40530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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
HIV-1 subtypes other than B are responsible for most new HIV infections worldwide; virus sequence data for drug resistance is described only from a limited number of non-B subtype HIV-1. This study is on mutations and polymorphisms of HIV-1 protease gene that can predict drug resistance in subtype C. The genotypic resistance assay was carried out on 38 HIV-1 strains with their plasma RNA and in nine, the proviral protease gene was sequenced. The treatment naïve strains showed minor resistance mutations, there were no major resistance mutations in the protease gene. We suggest the use of resistance testing to monitor individuals on therapy and also before initiation of therapy, gathering more sequence information for a data bank of Indian strains.
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Affiliation(s)
- A J Kandathil
- Department of Clinical Virology, Christian Medical College, Vellore-632 004, Tamil Nadu, India
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George IA, Mathews MS, Karthik R, John L, Sundar A, Abraham OC, Joseph V. Fatal cerebral abscess caused by Cladophialophora bantiana. J Assoc Physicians India 2008; 56:470-472. [PMID: 18822631] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Primary cerebral phaeohyphomycosis is caused by pigmented fungi that exhibit distinct neurotropism often in immunocompetent individuals. A 20-yr-old male presented with multiple brain abscess which was subsequently proven microbiologically to be due to Cladophialophora Bantiana. In spite of near total excision and appropriate antifungal agents succumbed to his illness. We report this case to highlight its rarity and high mortality in an immunocompetent host. There is no initial clinical or laboratory feature that makes a preoperative diagnosis possible and relies on microbiological confirmation.
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Affiliation(s)
- I A George
- Department of Medicine Unit 1 & Infectious diseases, Christian Medical College & Hospital, Vellore 632004
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Ramalingam S, Kannangai R, Abraham OC, Subramanian S, Rupali P, Pulimood SA, Jesudason MV, Sridharan G. Chemokine profile among human immunodeficiency virus-1 (HIV-1) infected individuals from southern India. Indian J Med Res 2008; 127:133-139. [PMID: 18403790] [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: 05/26/2023] Open
Abstract
BACKGROUND & OBJECTIVE Individuals infected with HIV-1 have higher levels of chemokine producing cells compared to uninfected individuals. It is important to know the changes in chemokine levels associated with rate of progression of disease. There is a paucity of information on the plasma chemokines in HIV-1 infected individuals from India. We therefore carried out this study to estimate the levels of three chemokines namely macrophage inflammatory protein alpha (MIP1alpha), MIP1beta and RANTES, in relation to disease status in HIV-1 infected individuals and compared with uninfected individuals. METHODS RANTES and MIP1alpha were estimated using ELISA in 114 HIV-1 infected and 30 controls, whereas MIP1beta was estimated in 101 HIV infected individuals only and 30 controls. The values were compared to the T cell subsets, HIV-1 viral loads and plasma cytokines (interferon gamma and interleukin-10). RESULTS Compared to controls the mean MIP1alpha and RANTES level among the HIV-1 infected individuals was higher while MIP1beta level was lower in HIV infected individuals except CDC C groups. There was a significant positive correlation for MIP1á with HIV-1 viral load and IFNgamma, for MIP1alpha with viral load and IL10. There was a significant negative correlation between MIP1alpha with CD4 count and CD4: CD8 ratio and MIP1beta with CD4 count and CD8 count. There was a negativecorrelation between RANTES values and CD8 per cent. INTERPRETATION & CONCLUSION In conclusion, our study showed a significantly higher level of beta chemokines in south Indian HIV-1 infected individuals compared to controls. These beta chemokines may have the inhibitory effect on HIV-1 only during the initial period and with the progression of disease this inhibitory effect wanes as shown by the positive correlation of beta chemokines with HIV-1 viral load.
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Affiliation(s)
- Sandeep Ramalingam
- Department of Clinical Virology, Christian Medical College, Vellore, India
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Abstract
BACKGROUND Meningococcal disease begins suddenly and death can follow within hours. Pre-admission antibiotic therapy aims to prevent delay in starting therapy that occurs if bacterial confirmation is sought before instituting therapy. OBJECTIVES To study the effectiveness and safety of pre-admission antibiotics versus no pre-admission antibiotics or placebo and of different pre-admission antibiotic regimens in decreasing mortality and morbidity in people suspected of meningococcal disease. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2007, Issue 1), MEDLINE (1966 to February 2007) and EMBASE (1980 to February 2007). SELECTION CRITERIA We selected randomised controlled trials (RCTs) or quasi-RCTs, of all people with suspected meningococcal infection. We compared antibiotic treatment versus placebo or no intervention, or different antibiotic treatments administered before admission to hospital or confirmation of the diagnosis. DATA COLLECTION AND ANALYSIS Two author authors independently assessed quality and extracted data from included trials. We calculated the relative risk (RR) and 95% confidence interval (CI) for dichotomous data. As only one trial fulfilled inclusion criteria, data synthesis was not performed. MAIN RESULTS No RCTs were found that compared pre-admission antibiotics versus no pre-admission antibiotics or placebo. One open-label RCT evaluated a single dose of intramuscular ceftriaxone versus a single dose of intramuscular long acting (oily) chloramphenicol. Interventions did not differ significantly in mortality (RR 1.2, 95% CI 0.5 to 2.6; N = 510; 349 confirmed meningococcal meningitis; 26 deaths), nor in proportions of survivors who developed neurological sequelae (RR 1.2, 95% CI 0.6 to 2.2; N = 488; 36 with neurological sequelae), or that were classified as clinical failures (RR 0.8, 95% CI 0.4 to 1.8; N = 488, 25 clinical failures). No adverse effects of treatment were seen. No data were available for our secondary outcomes. AUTHORS' CONCLUSIONS We found no reliable evidence to support or refute the use of pre-admission antibiotics for suspected cases of meningococcal disease. Evidence from one RCT-during an epidemic of meningococcal meningitis, indicated that single intramuscular injections of ceftriaxone and long-acting chloramphenicol were equally effective and safe in preventing mortality and morbidity. The choice between these antibiotics would be based on affordability, availability, and patterns of antibiotic resistance.Further RCTs comparing different pre-admission antibiotics, including penicillin, including participants with severe illness are ethically justifiable and are needed to provide reliable evidence to clinicians in differing clinical settings.
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Affiliation(s)
- T Sudarsanam
- Christian Medical College, Medicine Unit 2, Vellore, Tamil Nadu, India, 632 004.
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Kaul S, Brahmadathan KN, Jagannati M, Sudarsanam TD, Pitchamuthu K, Abraham OC, John G. One year trends in the gram-negative bacterial antibiotic susceptibility patterns in a medical intensive care unit in South India. Indian J Med Microbiol 2008; 25:230-5. [PMID: 17901640 DOI: 10.4103/0255-0857.34764] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To describe the changes in antibiotic susceptibility patterns of common intensive care unit pathogens with time from the medical intensive care unit of a tertiary care hospital. METHODS A prospective observational study was conducted in the medical intensive care unit (MICU) of a 2100 bed tertiary care hospital in South India. All data regarding patient characteristics, disease characteristics, infective agents, identified along with their antibiotic sensitivity patterns and patient outcomes were prospectively recorded in MICU data base. Various bacterial pathogen antibiotic sensitivity patterns from August 2004 to May 2005 were prospectively documented. During this period 491 patients were admitted to the MICU. Data were analyzed using excel spreadsheets. RESULTS Ceftazidime resistance reduced in Klebsiella spp. while cefotaxime resistance increased. In E. coli however, ceftazidime and cefotaxime resistance increased. Klebsiella resistance to cefotaxime and ceftazidime ranged from 25-50% and 14-91%, while E. coli resistance to these antibiotics ranged from 50-70% and 50 to 80% respectively. In Pseudomonas and the non-fermenting gram-negative bacteria (NFGNB) ceftazidime resistance decreased. Third generation cephalosporin resistance seemed to be reducing in the NFGNB, however, carbapenem resistance appeared to be increasing, possibly due to their increasing use. CONCLUSIONS This study demonstrates the trend in antibiotic susceptibility pattern (AST) of common gram negative infections seen in intensive care units. It demonstrates the changes seen especially after a change in the protocol antibiotic. Changes in the AST patterns of Klebsiella, E. coli, Pseudomonas and non-fermenting gram negative bacteria were seen. The data on the changing antibiotic susceptibility trends we believe is an important pillar in our efforts at infection control especially in intensive care settings.
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Affiliation(s)
- S Kaul
- Department of Medicine, Christian Medical College, Vellore - 632 004, Tamilnadu, India
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Kannangai R, Kandathil AJ, Ebenezer DL, Nithyanandam G, Samuel P, Abraham OC, Sudarsanam TD, Pulimood SA, Sridharan G. Evidence for lower CD4 + T cell and higher viral load in asymptomatic HIV-1 infected individuals of India: Implications for therapy initiation. Indian J Med Microbiol 2008; 26:217-21. [DOI: 10.4103/0255-0857.42031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Paul N, Mathai E, Abraham OC, Michael JS, Mathai D. Factors associated with candiduria and related mortality. J Infect 2007; 55:450-5. [PMID: 17706785 DOI: 10.1016/j.jinf.2007.06.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 04/11/2007] [Accepted: 06/22/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although candiduria and bacteriuria have many attributes in common, little data is available regarding factors associated specifically with candiduria. Despite the high mortality in subjects with candiduria, factors associated with such mortality have not been studied. METHODS We undertook a single-center case-control study to evaluate factors associated with candiduria over a 10.5 month period. Cases and controls were prospectively recruited from hospitalized subjects with candiduria and bacteriuria, respectively. A subgroup analysis was performed to identify factors associated with mortality following candiduria. RESULTS Among 145 subjects with candiduria, Candida tropicalis (30.5%) and other non-albicans species accounted for 71% of isolates. Among them, clinical characteristics and associations were studied among 80 hospitalized subjects. Prior antimicrobial use was documented in 92% with candiduria, with cephalosporins used most commonly. Independent associations with candiduria were demonstrated for use of antimicrobial agents in the preceding 30 days (odds ratio (OR) 8.1; 95% confidence interval (CI) 2.1-31.9) and plasma glucose > 180 mg/dL (OR 3.1; 95% CI 1.1-9.1). Death occurred among 21 (26.2%) subjects with candiduria. Factors associated with death included use of urinary diversion devices (OR 8.8; 95% CI 1.1-70.5), > or = 2 classes of antimicrobials (OR 4.1; 95% CI 1.2-13.9), intensive care (OR 3.3; 95% CI 1.1-9.3), and renal failure (OR 2.9; 95% CI 1.1-8.2). CONCLUSIONS Many risk factors traditionally linked to candiduria may be associated with urinary tract infections in general. Factors which predicted occurrence of candiduria, as opposed to bacteriuria, included prior use of antimicrobial agents and elevated plasma glucose. Since factors found to have associations with death in candiduria were those expected in seriously ill patients, the high mortality may be a function of the severity of underlying diseases.
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Affiliation(s)
- Navin Paul
- Department of Medicine 1 and Infectious Diseases, Christian Medical College, Vellore, India.
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Affiliation(s)
- Binu V John
- Department of Medicine, Christian Medical College, Vellore, Tamilnadu 632004, India.
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Kurien M, Thomas K, Ahuja RC, Patel A, Shyla PR, Wig N, Mangalani M, Kasthuri A, Vyas B, Brogen A, Brojen A, Sudarsanam TD, Chaturvedi A, Abraham OC, Tharyan P, Selvaraj KG, Mathew J. Screening for HIV infection by health professionals in India. Natl Med J India 2007; 20:59-66. [PMID: 17802983] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India. METHODS We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire. RESULTS A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patient's HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document. CONCLUSION There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.
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Affiliation(s)
- M Kurien
- Coordinating Centre, Christian Medical College, Vellore 632004, Tamil Nadu, India
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Abstract
Two specific serological tests, a Dot enzyme immunoassay (EIA) and an immunoglobulin (Ig)M enzyme-linked immunosorbent assay (ELISA) using the 56 kDa antigen and the Weil-Felix test were evaluated for diagnosis of scrub typhus. Sensitivity of 100, 86.5 and 43.5% were observed with Dot EIA, IgM ELISA and Weil-Felix test, respectively. False-positive reactions were observed in patients with falciparum malaria, pulmonary tuberculosis, S. viridans septicemia and typhoid fever using Dot EIA and IgM ELISA. Therefore, although Dot EIA and IgM ELISA are useful in the serodiagnosis of scrub typhus, efforts should be made to rule out other febrile illnesses.
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Affiliation(s)
- J A J Prakash
- Department of Clinical Microbiology, Unit I, Christian Medical College, Vellore-632004, India
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