Zika a Vector Borne Disease Detected in Newer States of India Amidst the COVID-19 Pandemic

Background

During the second wave of the COVID-19 pandemic, outbreaks of Zika were reported from Kerala, Uttar Pradesh, and Maharashtra, India in 2021. The Dengue and Chikungunya negative samples were retrospectively screened to determine the presence of the Zika virus from different geographical regions of India.

Methods

During May to October 2021, the clinical samples of 1475 patients, across 13 states and a union territory of India were screened and re-tested for Dengue, Chikungunya and Zika by CDC Trioplex Real time RT-PCR. The Zika rRTPCR positive samples were further screened with anti-Zika IgM and Plaque Reduction Neutralization Test. Next generation sequencing was used for further molecular characterization.

Results

The positivity was observed for Zika (67), Dengue (121), and Chikungunya (10) amongst screened cases. The co-infections of Dengue/Chikungunya, Dengue/Zika, and Dengue/Chikungunya/Zika were also observed. All Zika cases were symptomatic with fever (84%) and rash (78%) as major presenting symptoms. Of them, four patients had respiratory distress, one presented with seizures, and one with suspected microcephaly at birth. The Asian Lineage of Zika and all four serotypes of Dengue were found in circulation.

Conclusion

Our study indicates the spread of the Zika virus to several states of India and an urgent need to strengthen its surveillance.

Liver abscess in children – Clinical profile and outcome in a resource-limited setting

Background

Liver abscess continues to be a major cause of morbidity in developing countries. There is no gold standard for management; it has to be tailor made for each child depending on availability of resources. We aimed to study clinical features, laboratory parameters, treatment, and outcome of children with liver abscess in resource-limited settings.

Materials and Methods

This is a retrospective observational cohort study of children less than 16 years admitted in pediatric ward with diagnosis of liver abscess during 4 years duration (2016-2019). Demographic data, clinical features, laboratory, ultrasonographic (USG) and microbiological findings, management, and outcome were documented. For descriptive analysis, mean ± standard deviation/median with interquartile range, percentages were used and for testing association, Chi-square test and independent t-test were used. P value <0.05 was considered significant.

Results

The mean age of children was 8.4 ± 4.4 years (19- 7 male and 11 female). Fever with chills was the most common symptom (19, 100%), followed by right upper quadrant pain (18, 89.5%), vomiting (7, 36.8%), and pleural effusion (6, 31.6%). Of the 19 children, 26.3% (5) were moderately undernourished and 63.2% (12) severely undernourished. Among the laboratory parameters, leukocytosis (16, 84.2%), anemia (19, 100%), and raised C Reactive protein (CRP) (19, 100%) were seen. Liver abscess on USG was solitary in 14 (73.7%), multiple in five (26.3%), in the right lobe in 14 (73.7%), and left in five (26.3%) with average volume of 104.5 ± 79.2 cc. Blood culture was positive in 22.2% (4/19) with growth of Staphylococcus in 10.4% (2), Pseudomonas in 5.2% (1), and Escherichia coli in 5.2% (1). Pus culture was positive in one (1/8, 12.5%) showing Pseudomonas. Half (9/19) of children were managed on only antibiotics and the other half (10/19) were managed by USG-guided aspiration on two to three occasions along with antibiotics successfully with no mortality.

Conclusion

High index of suspicion in children with fever, right upper abdomen pain, positive CRP, and anemia should prompt an urgent USG. Liver abscess can be successfully managed by intravenous antibiotics and USG-guided aspiration in larger abscess, with no mortality. However, in case of signs of impending perforation, surgical management should be considered.

Fosfomycin versus Nitrofurantoin for the Treatment of Lower UTI in Outpatients

Introduction Fosfomycin and nitrofurantoin are increasingly being prescribed in outpatients for the oral treatment of urinary tract infection (UTI). Although ample literature is available on the in vitro sensitivity pattern of fosfomycin and nitrofurantoin in UTI cases, clinical data are scant.

Methodology  Voided midstream urine, collected from patients ≥ 16 years of age of both genders with suspected sign and symptoms, was plated on cystine lactose electrolyte-deficient agar. Uropathogen was defined as an organism known to be associated with the signs and symptoms of UTI with > 10 ⁵ colony forming units/mL of urine. Antimicrobial susceptibility testing was determined by Kirby-Bauer disc diffusion method. Further, for fosfomycin, agar dilution method was also performed.

Results  A total of 143 patients, 47 treated with fosfomycin and 96 with nitrofurantoin, were followed for clinical outcome. The most common isolated uropathogen was Escherichiacoli . In vitro susceptibility rate of uropathogens against fosfomycin and nitrofurantoin was 99.3% and 81.2%, respectively. Overall, the clinical cure rate with fosfomycin and nitrofurantoin treatment groups was 80.85% and 90.06% respectively (not statistically significant).

Conclusion  Fosfomycin and nitrofurantoin showed good in vitro activity against uropathogens from lower UTI and can be used for empirical therapy in our area. Multiple confounding factors may have contributed to the discrepancy between in vitro susceptibility and clinical cure, which needs to be studied further.

An Epidemiological Analysis of SARS-CoV-2 Genomic Sequences from Different Regions of India

The number of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) cases is increasing in India. This study looks upon the geographic distribution of the virus clades and variants circulating in different parts of India between January and August 2020. The NPS/OPS from representative positive cases from different states and union territories in India were collected every month through the VRDLs in the country and analyzed using next-generation sequencing. Epidemiological analysis of the 689 SARS-CoV-2 clinical samples revealed GH and GR to be the predominant clades circulating in different states in India. The northern part of India largely reported the ‘GH’ clade, whereas the southern part reported the ‘GR’, with a few exceptions. These sequences also revealed the presence of single independent mutations—E484Q and N440K—from Maharashtra (first observed in March 2020) and Southern Indian States (first observed in May 2020), respectively. Furthermore, this study indicates that the SARS-CoV-2 variant (VOC, VUI, variant of high consequence and double mutant) was not observed during the early phase of virus transmission (January–August). This increased number of variations observed within a short timeframe across the globe suggests virus evolution, which can be a step towards enhanced host adaptation.

Fosfomycin Sensitivity Pattern among Uropathogens Isolated from Patients Visiting Day Care Facility of Sushila Tiwari Hospital in Kumaun Region, Uttarakhand, India

Introduction: Urinary Tract Infections (UTI) are one of the most common infections responsible for antibiotic resistance. There are limited antibiotics options for treating the cases due to Multi Drug Resistant (MDR) bacteria. Fosfomycin is being used for treating UTIs and has shown promising results even against MDR pathogens. Aim: To determine the fosfomycin sensitivity pattern along with Minimum Inhibitory Concentration (MIC) against uropathogens by agar dilution method. Materials and Methods: The present cross-sectional study was conducted in the Department of Microbiology, Government Medical College Haldwani, Uttarakhand, India, between August 2017 to September 2019. Clean catch, mid stream urine samples were inoculated on Cystine Lactose Electrolyte Deficient (CLED) agar and incubated. The significant growths of pathogenic bacteria were subjected to antibiotic susceptibility testing. Fosfomycin (200 μg) disc was used in Kirby-Bauer disc diffusion testing. Fosfomycin trometamol MIC was determined by agar dilution method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. The data collected in the study were analysed by using Statistical Package for the Social Science (SPSS) software version 20.0. Results: Significant growth of pathogenic bacteria was observed in 365 out of total 2725 urine samples. E.coli (72.32%) was the leading isolate followed by Enterococcusspecies (10.41%). Fosfomycin was recorded as the most active antibiotic against all the bacterial pathogen with 85-100% susceptibility except Proteus species (40%) in disc diffusion method. The MIC of fosfomycin was recorded between 4-64 against most of the isolates by agar dilution method. Conclusion: Fosfomycin is the most active antibiotic against all the uropathogens in the study setup and can be included in empirical treatment of day care patients along with nitrofurantoin.

A Comparative Analysis of Four Different Diagnostic Techniques for Malaria

Introduction: Malaria is one of the major parasitic diseases and laboratory diagnosis of malaria infection requires the availability of a rapid, sensitive, and specific test that is affordable. There is the availability of several laboratory procedures for malaria diagnosis. Aim: To compare the performance of conventional microscopy using leishman staining against an immunochromatographic antigen detection test, fluorescent microscopy using Acridine Orange (AO), and molecular technique by Polymerase Chain Reaction (PCR) in the laboratory diagnosis of malaria. Materials and Methods: In the present cross-sectional study, 432 specimens were collected from patients suspected of malaria attending Dr. Susheela Tiwari Government Hospital, Haldwani, Uttarakhand, India, during the study period from January 2018 to September 2019. Microscopic examinations of Leishman stained smears, immunochromatographic Rapid Diagnostic Test (RDT), fluorescent microscopy using AO, and PCR were done using appropriate statistical analysis. Results: Out of the 432 specimens tested, a total of 208 (48.2%) were found positive for malaria using all four tests. Microscopy using leishman staining, RDT, and fluorescent microscopy were performed on all samples out of which 180 (41.6%) samples showed a positive result on Leishman staining, 186 (43%) were detected using AO fluorescent microscopy while the RDT had a yield of 208 (48.2%) positive results for malaria. While PCR was performed on 124 samples that yielded 79 (63.7%) positive results. Conclusion: Though, peripheral blood smears are still considered the gold standard for malaria diagnosis. But, in this study, it was observed that newer RDT for malaria surpassed the diagnostic efficacy of clinical microscopy and hence, has a superior role in clinical practice and diagnosis.

Vancomycin, linezolid and daptomycin susceptibility pattern among clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) from Sub- Himalyan Center

INTRODUCTION:

The efficacy of vancomycin, drug of choice for methicillin-resistant Staphylococcus aureus (MRSA), has become questionable due to the emergence of MRSA isolates with reduced susceptibility. The present study was conducted to determine the vancomycin, linezolid, and daptomycin susceptibility pattern in clinical isolates of MRSA and to observe minimum inhibitory concentration (MIC) creep over 2 years if any.

MATERIALS AND METHODS:

MIC of vancomycin, linezolid, and daptomycin were determined by E-test in 198 MRSA isolates and their MIC 50, MIC 90, and geometric mean MIC were calculated.

RESULTS:

While all isolates were sensitive to vancomycin, linezolid, and daptomycin, MIC 90 of vancomycin increased from 1.5 μg/ml in 2015 to 2 μg/ml in 2016. The percentage of isolates with vancomycin MIC >2 μg/ml doubled in 2016 (12.9%) as compared to 2015 (6.1%). MIC 90 for linezolid remained steady as 3 μg/ml, but geometric mean MIC increased from 2.20 μg/ml in 2015 to 2.29 μg/ml in 2016, and more than 40% isolates showed MIC 3 μg/ml. MIC 90 and geometric mean MIC of daptomycin decreased from 0.75 μg/ml to 0.5 μg/ml and 0.50 μg/ml to 0.36 μg/ml in 2015 and 2016, respectively.

CONCLUSION:

MIC creep was observed with vancomycin. Although linezolid MIC was within the susceptible zone, more than 40% strains showing MIC 3 μg/ml may herald the future development of either resistant or heteroresistant. Daptomycin showed good sensitivity against MRSA isolates. Therefore, it could be considered as an alternative agent for the treatment of infections caused by MRSA. However, it should be reserved where this class has a clear therapeutic advantage over other anti-MRSA drugs.

Species C Rotaviruses in Children with Diarrhea in India, 2010-2013: A Potentially Neglected Cause of Acute Gastroenteritis

All over the world, children and adults are severely affected by acute gastroenteritis, caused by one of the emerging enteric pathogens, rotavirus C (RVC). At present, no extensive surveillance program is running for RVC in India, and its prevalence is largely unknown except cases of local outbreaks. Here, we intended to detect the presence of RVC in diarrheic children visiting or admitted to hospitals in Haldwani (state of Uttarakhand, India), a city located in the foothills of the Himalayas. During 2010-2013, we screened 119 samples for RVC by an RVC VP6 gene-specific RT-PCR. Of these, 38 (31.93%) were found positive, which is higher than the incidence rates reported so far from India. The phylogenetic analysis of the derived nucleotide sequences from one of the human RVC (HuRVC) isolates, designated as HuRVC/H28/2013/India, showed that the study isolate belongs to genotype I2, P2 and E2 for RVC structural genes 6 and 4 (VP6, and VP4) and non-structural gene 4 (NSP4), respectively. Furthermore, the VP6 gene of HuRVC/H28/2013/India shows the highest similarity to a recently-reported human-like porcine RVC (PoRVC/ASM140/2013/India, KT932963) from India suggesting zoonotic transmission. We also report a full-length NSP4 gene sequence of human RVC from India. Under the One-health platforms there is a need to launch combined human and animal RVC surveillance programs for a better understanding of the epidemiology of RVC infections and for implementing control strategies.Reoviridae, possess 11 double-stranded segments of RNA that encode six structural viral proteins (VP1, VP2, VP3, VP4, VP6, VP7) and five/six non-structural proteins (NSP1-NSP5/6) [7]. Based on the antigenic properties of the major inner capsid protein (VP6), RVs are subdivided into eight well-characterized species (A-H) and two putative species viz. I and J [8-10]. Humans and other mammalian species are affected by species A, B, C and H rotaviruses and birds by species D, F and G, and species E has been reported exclusively in pigs [7,8,11-17]. The newly-proposed species I is reported in dogs [18] and cats [19], whereas species J is found in bats [10].

Epidemiological, clinical and laboratory profile of scrub typhus cases detected by serology and RT-PCR in Kumaon, Uttarakhand: a hospital-based study

We analysed the epidemiology, clinical and laboratory data of the 168 scrub typhus cases confirmed by a combination of any one of the following: real time polymerase chain reaction (RT-PCR) and/or immunofluorescence assay (IFA) (IgM and/or IgG). The peak season for scrub typhus was from July to October. By multivariate binary logistic regression analysis, the risk of scrub typhus was about four times in those working in occupation related to forest work. Major clinical manifestations were fever (100%), myalgia (65%), cough (51%) and vomiting (46%); major complications were meningitis/meningoencephatilitis (12.5%) and multi-organ failure (MOF) and pneumonia (5.3% each). Laboratory investigations revealed raised aminotranferase levels and thrombocytopenia in most confirmed cases. We conclude that scrub typhus is an important cause of febrile illness in the Kumaon hills of Uttarakhand where this disease had not previously been considered to exist.

Susceptibility Pattern of Enterococci at Tertiary Care Hospital

The study was aimed to characterize enterococci from various clinical specimens, to determine the antimicrobial susceptibility pattern, and to explore the association between virulence factors and antimicrobial resistance. A total of 283 clinical enterococcal isolates were speciated and subjected to antimicrobial susceptibility testing. Virulence factors (hemolysin, gelatinase, and biofilm production) were detected phenotypically. Of the 283 enterococci isolated, 12 species were identified; predominant species were Enterococcus faecalis (82.33%). High-level gentamicin (HLG) and vancomycin resistance were observed among 55.57% and 6.01% of enteroccal isolates, respectively. All vancomycin-resistant enterococci (VREs) were E. faecalis and had VanA phenotype and genotype. Hemolysin, gelatinase, and biofilm production were seen in 15.90%, 12.36%, and 13.43% of enterococcal isolates, respectively. Vancomycin and HLG resistance were observed in 0.35% and 61.86% of the enterococcal isolates producing virulence factors. Isolates resistant to HLG but susceptible to vancomycin expressed more virulent factors. Further research is required to reveal the complex interplay between drug resistance and virulence factors.

Role of Haematological Changes in Predicting Occurrence of Leishmaniasis- A Study in Kumaon Region of Uttarakhand

INTRODUCTION

A number of cases of Leishmaniasis have been reported from non-endemic sub-himalayan regions of India. Due to low clinical suspicion and atypical presentation, cases may go undetected or there may be a delay in diagnosis.

AIM

The aim of the study was to evaluate clinico-haematological parameters and bone marrow findings so that a high degree of suspicion could be made in unsuspected cases of Visceral Leishmaniasis (VL) and Leishman Donovan (LD) body negative bone marrow smears.

MATERIALS AND METHODS

A retrospective study was conducted at a tertiary care centre serving the kumaon region of Uttarakhand from 2010 to 2014. Forty bone marrow aspirates were included, which were sent on clinical suspicion of VL. Twenty cases were positive for LD bodies. Their clinico-haematological features including bone marrow findings were studied in detail and compared with rest of the 20 LD negative cases. Five LD negative cases were also positive for rk39.

RESULTS

Twenty LD positive cases were evaluated. Splenomegaly was the most common sign present in 17 cases (85%). Anaemia, leucopenia and lymphocytosis were present in all the cases (100%). Pancytopenia was seen in 17 cases (85%). Microcytic hypochromic blood picture was the most common finding in 11 cases (55%). Bone marrow was normocellular in 7 cases (35%), hypercellular in 7 cases (35%). Erythropoesis was micro-normoblastic in 11 cases (55%). Overall, there were 25 cases of VL (20 LD positive, 5 LD negative). Increased plasma cells, lymphocytes and histiocytes were seen in 17 cases (68%) of VL.

CONCLUSION

In non-endemic region where clinical suspicion is low, bone marrow findings can be a strong indicator for VL even though marrow is negative for LD bodies. If required other ancillary investigations can also be ordered. This study also emphasizes the need for epidemiological work up in this region.

Acute abdomen: An uncommon presentation of a common intestinal nematode

Enterobius vermicularis is a common parasitic infection of the intestine which is rarely symptomatic. It is unusual to find it in the wall or outside the gastrointestinal tract. We encountered five such cases where we observed the worm outside the lumen of the intestine. The pathological findings and the clinical features are discussed. This case series highlight that E. vermicularis can be the cause of pathology within the abdomen and should be considered in the differential diagnosis of some commonly encountered abdominal conditions.

Cissus quadrangularis Linn exerts dose-dependent biphasic effects: osteogenic and anti-proliferative, through modulating ROS, cell cycle and Runx2 gene expression in primary rat osteoblasts

OBJECTIVES

This report highlights phytoconstituents present in Cissus quadrangularis (CQ) extract and examines biphasic (proliferative and anti-proliferative) effects of its extract on bone cell proliferation, differentiation, mineralization, ROS generation, cell cycle progression and Runx2 gene expression in primary rat osteoblasts.

MATERIALS AND METHODS

Phytoconstituents were identified using gas chromatography-mass spectroscopy (GC-MS). Osteoblasts were exposed to different concentrations (10-100 μg/ml) of CQ extract and cell proliferation and cell differentiation were investigated at different periods of time. Subsequently, intracellular ROS intensity, apoptosis and matrix mineralization of osteoblasts were evaluated. We performed flow cytometry for DNA content and real-time PCR for Runx2 gene expression analysis.

RESULTS

CQ extract's approximately 40 bioactive compounds of fatty acids, hydrocarbons, vitamins and steroidal derivatives were identified. Osteoblasts exposed to varying concentrations of extract exhibited biphasic variation in cell proliferation and differentiation as a function of dose and time. Moreover, lower concentrations (10-50 μg/ml) of extract slightly reduced ROS intensity, although they enhanced matrix mineralization, DNA content in S phase of the cell cycle, and levels of Runx2 expression. However, higher concentrations (75-100 μg/ml) considerably induced the ROS intensity and nuclear condensation in osteoblasts, while it reduced mineralization level, proportion of cells in S phase and Runx2 level of the osteogenic gene.

CONCLUSIONS

These findings suggest that CQ extract revealed concentration-dependent biphasic effects, which would contribute notably to future assessment of pre-clinical efficacy and safety studies.

Measles outbreak investigation in Dwarahat block of District Almora, Uttarakhand

BACKGROUND

We report an assessment of measles outbreak during the months of February 2014 to April 2014 in Dwarahat block of district Almora and the response mounted to it.

MATERIALS AND METHODS

An intensive door-to-door search to six measles affected villages in Dwarahat block of district Almora, covering a population of 2,408 was carried out to identify the cases of measles by a rapid response team (RRT). A total of ten blood samples were randomly collected for detecting IgM antibody against measles. For all cases, information on personal details, place of residence, time of onset and status of immunization were obtained.

RESULTS

Overall attack rate (AR) was 2.8%. AR among the population of age-group 0-16 was 7.2%. Statistically significant higher AR (16.26%) was seen for the age-group of 0-5 years as compare to 6-10 and 11-16 years of age (AR-8.71, relative risk-0.53, 95% confidence interval-0.32-0.88, P value-0.012 and AR-0.57%, relative risk-0.035, 95% confidence interval-0.00-0.14, P value-0.000, respectively). Males were affected more often than females 35 [59.2%] vs. 24 [40.8%]. Measles-related complications were seen in three children. No death was reported. Of the 10 samples, nine were positive for measles IgM antibodies by enzyme-linked immunosorbent assay (ELISA).

CONCLUSION

The recognition of early warning signals, timely investigation and application of specific control measures can contain the outbreak. The unvaccinated or partially protected human beings serve as the reservoir of measles virus. Hence, there is a need for sero surveillance for measles in Uttarakhand and one catch up measles immunisation campaign to prevent future outbreak.

Antibacterial activity of Withania somnifera against Gram-positive isolates from pus samples

Background:

Withania somnifera is an important medicinal plant that has been used in Ayurvedic and indigenous medicine since ancient times. In the view of its varied therapeutic potential, it has also been the subject of considerable modern scientific attention. Attention has been drawn to antibacterial activity of the plant and its metabolites due to the challenge on growing antibacterial resistant pathogens.

Aim:

To examine the antimicrobial potential of leaf extract of W. somnifera against Gram-positive cocci.

Materials and Methods:

In this study, leaf extract of W. somnifera was used to examine their antimicrobial potential against Gram-positive cocci (n = 20) from pus samples of patients admitted in Government Medical College, Haldwani. Agar well diffusion method was used by taking methanolic leaf extract of W. somnifera.

Results:

It was observed that the methanolic leaf extract of W. somnifera was very effective in inhibiting the test pathogens including methicillin resistant Staphylococcus aureus and Enterococcus spp., with an average zone of inhibition of 20.6 mm and 19.4 mm at 2 mg/ml (100 μl) concentration, respectively.

Conclusion:

These results indicate that the antimicrobial property of W. somnifera leaf supports the traditional use of the plant in therapeutic use against microbial infections.

Epidemiological investigation of the jaundice outbreak in lalkuan, nainital district, uttarakhand

BACKGROUND

In March 2013, cases of acute hepatitis were reported from Lalkuan, Nainital district. We investigated the outbreak to identify the source of infection and to facilitate control measures.

OBJECTIVES

To study the distribution of hepatitis cases, to find the source of infection, and to initiate the control measures in the affected area.

MATERIALS AND METHODS

WE DEFINED A CASE OF ACUTE HEPATITIS AS THOSE CASES THAT HAD JAUNDICE WITH AT LEAST ONE OF THE FOLLOWING SYMPTOMS: Dark urine, fever, pain in abdomen, vomiting, and loss of appetite in the affected area between January and March 2013. Door-to-door survey was carried out. Thirteen blood samples were randomly collected from jaundice cases for immunoglobulin M (IgM) antibody for hepatitis A virus (HAV) and hepatitis E virus (HEV). Water samples were collected to test residual chlorine.

RESULTS

Total 2,785 individuals were surveyed; of which 240 were suffering from acute viral hepatitis (attack rate (AR) = 8.61%). Out of 13 serum samples, 10 were found positive for HEV IgM antibodies and three cases had IgM antibodies for both HAV and HEV, which confirmed a hepatitis E outbreak. The difference in attack rate of hepatitis of both the sexes was statistically significant (P < 0.001). The attack rate was significantly higher in age groups >12 years of age (P < 0.001). Environmental investigation also confirmed the sewage contamination of drinking water in the distribution system. The attack rate was much higher (29.4%) among those who were exposed to the leaking pipeline than the nonexposed (χ(2) = 574.26, P < 0.01).

CONCLUSION

HEV was confirmed as the major etiological agent in this outbreak that was transmitted by contaminated drinking water. The recognition of early warning signals, timely investigation, and application of specific control measures can contain the outbreak.

Concomitant detection of biofilm and metallo-beta-lactamases production in gram-negative bacilli

Carbapenems are mainstay of treating serious multidrug resistant gram-negative biofilm-based infections. However, recent emergence of metallo-beta-lactamases (MbL) producing gram-negative bacilli in different parts of world may be related to gain of virulence factors associated with biofilm production.

OBJECTIVES

To explore the association of MbL and biofilm production in various gram-negative bacilli.

MATERIALS AND METHODS

In this study, 110 non-repetitive ceftazidime resistant gram-negative bacilli were evaluated for biofilm and MβL production. Biofilm forming ability of isolates obtained from various specimens was tested by the tube method. Disks of ceftazidime (30 μg) and ceftazidime with ethylenediaminetetraacetic acid (30 μg + 750 μg, prepared in house) for MβL detection were used. Chi-square test was used to study the association between biofilm and MβL production. P value <0.05 was considered significant.

RESULTS

88 (80%) bacilli had shown biofilm producing ability. The association of biofilm and MβL was significant in cases of non-fermenters as compared to enterobacteriaceae members.

CONCLUSION

The particular combination of virulence factors (biofilm and MβL) in bacteria may be a species specific effect which needs to be investigated at molecular level in detail. This may help in designing newer therapies based on interference with biofilm formation and thus countering clinical episodes of antibiotic resistance.

Detection of Different β-Lactamases and their Co-existence by Using Various Discs Combination Methods in Clinical Isolates of Enterobacteriaceae and Pseudomonas spp

Background:

Resistance to broad spectrum beta-lactams mediated by extended spectrum β-lactamase (ESBL), AmpC, and metallobetalactamase (MBLs) enzymes are an increasing problem worldwide. The study was aimed to detect occurrence rate and to evaluate different substrates and inhibitors by disc combination method for detecting varying degree of β-lactamase enzymes and their co-production.

Materials and Methods:

A disc panel containing imipenem (IMP), IMP/EDTA, ceftazidime (CA), ceftazidime-tazobactum (CAT), CAT/cloxacillin (CLOX), ceftazidime-clavulanic acid (CAC), CAC/CLOX, cefoxitin (CN), and CN/CLOX in a single plate was used to detect presence of ESBLs, AmpC, and MBLs and/or their co-existence in 184 consecutive, nonrepetitive, clinical isolates of Enterobacteriace (n = 96) and Pseudomonas spp. (n = 88) from pus samples of hospitalized patients, resistant to 3^rd generation cephalosporins.

Results:

Out of a total of 96 clinical isolates of Enterobacteriaceae, 18.7, 20.8, and 27% were pure ESBL, AmpC, and MBL producers, respectively. ESBL and AmpC were co-produced by 25% isolates. Among 88 Pseudomonas spp. 38.6, 13, and 6% were pure MBL, ESBL, and AmpC producers, respectively. ESBL/AmpC and MBL/AmpC co-production was seen in 20% and 18% isolates, respectively. Among ESBL and AmpC co-producers, CA/CAC/CLOX disc combination (DC) missed 7 of the 24 ESBL producers in Enterobacteriace and 4 of the 18 ESBL in Pseudomonas spp., which were detected by CA/CAT/CLOX DC. No mechanism was detected among 8.3% Enterobacteriaceae and 2.3% Pseudomonas isolates.

Conclusion:

Diagnostic problems posed by co-existence of different classes of β-lactamases in a single isolate could be solved by disc combination method by using simple panel of discs containing CA, CAT, CAT/CLOX, IMP, and IMP/EDTA.

Colonization of peripheral intravascular catheters with biofilm producing microbes: Evaluation of risk factors

BACKGROUND

Biofilms often colonize catheters and contribute to catheter-related septicemia. However, predictors of catheter colonization by biofilms remain poorly defined. The aim of this study was to evaluate clinical factors that may be associated with biofilm colonization of catheters.

MATERIALS AND METHODS

A total of 54 isolates colonizing the peripheral intravascular catheters (IVCs) were studied and their biofilm production ability was analyzed by the tube method and antimicrobial susceptibility was also done. A detailed clinical history and examination was done of each subject to know age, sex, duration of use of IVCs, site of IVCs, swelling/purulence around the IVCs, number of attempts to install the catheter, and duration of hospital stay.

RESULTS

44 (81.4%) out of 54 isolates colonizing the catheters showed biofilm formation. Biofilm formations were significantly associated with duration of hospital stay of more than 7 days [odds ratio (OR) = 6.6; 95% confidence interval (CI) = 1.3-34; P value (P) = 0.02], multiple attempts to install the catheter (OR=7; CI=1.5-31.8; P=0.01), and multidrug resistance (OR=9.5; CI=1.8 - 51.1: P=0.008). Klebsiella pneumoniae and Candida spp. comprised most of the biofilm-producing isolates. The overall susceptibility to antimicrobials was low among biofilm-producing compared to nonbiofilm-producing microbes.

CONCLUSION

The results of this study suggest that evaluation of predictors of biofilm production is important in order to understand, prevent or manage biofilm colonization of IVCs.

Bacteriological and resistance profile in isolates from diabetic patients

BACKGROUND

Diabetes mellitus has become a global epidemic illness and poses a threat for development of resistant bacterial infections.

AIM

This study was aimed to know the bacteriological and resistance profile of isolates obtained from diabetic patients.

MATERIALS AND METHODS

The bacterial isolates obtained from various samples of diabetic patients admitted in medicine department in 6-month period were identified and tested for antibiotic susceptibility. The extended spectrum beta-lactamases (ESβL), AmpC, and metallo-beta-lactamases (MβL) enzymes were detected in gram-negative bacilli. Methicillin, macrolide-lincosamide-streptogramin (MLS), and linezolid resistance in Staphylococcus spp. were detected. High-level aminoglycoside resistance (HLAR) in Enterococcus spp. was also tested.

RESULTS

In all, 38 of 125 diabetic patients (30.4%) had bacterial infection, 18 patients had wound infections, 18 had urinary tract infections (UTIs), and 2 had respiratory tract infections. Escherichia coli among gram-negative bacteria and Staphylococcus aureus among gram-positive bacteria were the predominant pathogens. 32.5% gram-negative bacilli were AmpC producers, 37.5% were MβL producers, and 40% were ESβL producers. Methicillin and MLS resistance was found in 50% and 33.3% isolates of Staphylococcus spp., respectively. HLAR resistance was alarming in Enterococcus spp. Polymyxin among gram-negative bacteria and vancomycin for gram-positive bacteria were the last resort with highest susceptibility rates to treat infections among diabetic patients.

CONCLUSION

Resistant bacterial infections in diabetic patients are common. The presence of various resistance mechanisms in isolates of our study shows that therapeutic failure can occur if empirical prescription is unsubstantiated.

Primary pulmonary sporotrichosis in a sub-Himalayan patient

Primary pulmonary sporotrichosis, a rare fungal disease was found in chronic alcoholic farmer from the sub-Himalayan region, an endemic mycoses area. Primary pulmonary sporotrichosis is a hidden entity, at times mimicking tuberculosis, and often under or lately diagnosed due to lack of awareness. We should consider the possibility of pulmonary sporotrichosis in patients with chronic cough and cavitary parenchymal disease, particularly in chronic alcoholics, gardeners, and forest workers. Sputum culture for fungus as a part of diagnostic studies is needed especially in endemic mycoses areas for early detection and management of such fungal diseases.

The bacteriological quality of drinking water in Haldwani block of Nainital district, Uttarakhand, India

A cross-sectional study was conducted to assess the bacteriological quality of water in Haldwani block, Nainital District, India. Stratified random sampling was used to categorize water sources and consumer points. In total, 108 samples were collected: 15 from the Gola river, 51 from water taps, 24 from water treatment plants and 18 from tube wells. Samples were tested for coliforms by the most probable number technique. Identification of species was done by standard procedures. Of 108 water samples, 58.8% were found to be polluted. All samples of water (n = 15) from different sites of the Gola river were found to be highly contaminated. Out of 24 water treatment plant samples, four samples were found unsatisfactory, while more than half (51.6%) of its supplies to water taps were polluted. From tube wells and their water taps, 88.8 and 60% samples were found safe for drinking respectively. Bacterial contamination of water treatment plants and their supplies indicates significant disparities in the efficiency of water treatment processes. Contamination of water taps of tube wells suggests leakage of pipes. There is an urgent need to improve these services to ensure the supply of safe water for consumers.

Antibiotic resistance pattern of urinary tract isolates of Escherichia coli from Kumaun region

Concurrent resistance to antimicrobials of different classes has arisen in a multitude of bacterial species and may complicate the therapeutic management of infections, including those of the urinary tract. To assess the resistance pattern among urinary isolates of E. coli, the most prevalent pathogen contributing these infections, a retrospective in vitro surveillance study was carried out in the Department of Microbiology, Uttarakhand Forest Hospital Trust Medical College from Jan. 2006 - Dec. 2006. A total of 175 E. coli isolates from urinary specimen had been tested against 12 antimicrobials. E. coli isolates tested, 94.29% showed resistance to ampicillin, 92% to amoxycillin- salbactam, 70.86% to gentamicin, 65.71% to amikacin, 89.71% to cefuroxime, 78.51% to cefotaxime,76% to cefriaxone, 90.28% to ciprofloxacin, 61.14% to chlormphenicol, 46.28% to nitrofurantoin, 28% to piperacillin-tazobactam and 8.5% to imipenum. Multidrug resistance was defined as resistance to three or more classes of antibiotics. Multidrug resistance was detected in 97% isolates. These findings call for wiser use of antimicrobial agents and their continuous in vitro monitoring.

Vitamin D deficiency in rural girls and pregnant women despite abundant sunshine in northern India

CONTEXT

Vitamin D deficiency is common in urban Indians despite living in the tropics and its public health consequences are enormous. However, 70% of India is rural, and data from rural subjects, who are expected to have good sun exposure, are scant.

OBJECTIVES

To determine the population prevalence of vitamin D deficiency in rural pregnant women and adolescent girls, compare serum 25-hydroxyvitamin D (25OHD) status in adolescent boys from the same families, and determine seasonal differences in serum 25OHD.

DESIGN

A cross-sectional study conducted over 18 months.

SUBJECTS

A random selection of 121 adolescent girls from a survey of a population of 8270 in a rural low socioeconomic community; 139 pregnant women in the second trimester; and a subset of 28 adolescent girls compared with 34 brothers.

MEASUREMENTS

Serum 25OHD, serum alkaline phosphatase (AP), sun exposure, and dietary calcium intake.

RESULTS

The age-adjusted community prevalence of vitamin D deficiency (25OHD < 50 nmol/l) in adolescent girls was 88.6%. Seventy-four per cent of pregnant women had vitamin D deficiency. Mean +/- SD 25OHD in girls and women in summer was 55.5 +/- 19.8 nmol/l compared to 27.3 +/- 12.3 nmol/l in winter (P < 0.001). Winter serum 25OHD in boys (67.5 +/- 29.0 nmol/l) was higher than that in their sisters (31.3 +/- 13.5 nmol/l, P < 0.001).

CONCLUSION

We report a high prevalence of vitamin D deficiency among pregnant women and adolescent girls from a rural Indian community. Boys are relatively protected. Seasonal variation in serum 25OHD is significant at latitude 26 degrees N.

Candidacolonization in preterm babies admitted to neonatal intensive care unit in the rural setting

PURPOSE

Candida colonization in neonates results in significant morbidity and mortality. The purpose of this study was to determine colonization of Candida spp. in preterm babies and identify the risk factors.

METHODS

Swabs from oral, rectum, groin and umblicus of 103 preterm and 100 term neonates were obtained within 24 hours of birth, day three, day five, day seven and thereafter every week till the neonate was admitted in the neonatal intensive care unit (NICU). Swabs were also collected from the mother's vagina prior to delivery. Twice every month, air of the NICU was sampled by settle plate and swabs were collected from the hands of health care workers and inanimate objects of NICU. Identification and speciation was done by standard methods. Antibiotic sensitivity was studied against amphotericin B, ketoconazole and fluconazole by disk diffusion method.

RESULTS

Colonization with Candida was significantly higher in preterms. Earliest colonization was of oral mucosa and 77.1% of the preterms had colonised at various sites by the first week of life. Significant risk factors in colonized versus non-colonized preterms were male sex, longer duration of rupture of membranes (DROM), administration of steroids and antibiotics and vaginal colonization of mothers, whereas those in preterms versus terms were low birth weight and gestational age. C. albicans was the commonest species, both in the colonized preterms (45.9%) and vagina of mothers. Resistance was seen to fluconazole and ketoconazole only. No Candida spp. was isolated from health care personnel or environment.

CONCLUSIONS

Colonization of preterms by Candida is a significant problem in NICU and the significant risk factors observed in colonized preterms were male sex, longer DROM, administration of steroids and antibiotics and vaginal colonization of mothers.