Seroprevalence and risk factors of human cystic echinococcosis in Central and North Kashmir, India

Cystic echinococcosis (CE) is a dreadful zoonotic neglected disease that affects public health globally. The infection is highly endemic in northern India (Kashmir valley). The present survey based study was done to know the seroprevalence of cystic echinococcosis infection among residents of north and central Kashmir valley and to identify risk variables linked to this infection. In addition to collecting 462 serum samples (244 males and 218 females), a questionnaire was also filled out for each participant utilizing systematic random sampling from June to November 2019 in 16 villages and 6 districts. Using a commercial enzyme-linked immunosorbent assay (ELISA) kit, the samples were tested for immunoglobulin G. Of the 462 serum samples obtained, 33 (7.14 percent) were found to be positive. Results showed that age group, gender, contact with dogs, occupation, and literacy rate were significantly related with the rate of seroprevalence of cystic echinococcosis infection in Central and North Kashmir. Statistics showed that the observations were significant (P< 0.05). Children, men, and those who were uneducated had considerably greater rates of seropositivity for this infection

Seroprevalence of Rickettsial disease: A population-based survey from kashmir valley, North India

Background: Limited studies have been done regarding the prevalence of Rickettsial diseases in India and as far as UT of Jammu and Kashmir is concerned, only a few hospital-based studies are available. Objectives: The present study was therefore planned to find the seroprevalence of Rickettsial diseases in Kashmir Valley. Materials and Methods: A multistage sampling procedure was used for the collection of samples from 10 districts of Kashmir Valley and a total of 1740 samples were collected. In addition, 802 healthy blood donors were included to establish baseline titers for Weil–Felix (WF) Test. Results: Of 1734 subjects, 73 were positive by the WF test. The overall seroprevalence of Rickettsial diseases was 4.1% with the highest prevalence of scrub typhus (2.30%) followed by the spotted fever group (1.5%) and typhus group (0.40%). Maximum seropositive subjects were from district Kulgam (6.97%) followed by Pulwama (5.92%), Shopian (5.79%), Anantnag (5.47%), Ganderbal (5.00%), Kupwara (4.72%), Baramulla (4.62%), Srinagar (2.63%), Bandipora (2.41%), and Budgam (0.54%), respectively. Seropositivity was higher in females and subjects who had contact with ticks and mites like those involved in the collection of firewood and grass or had contact with uncut grass or shrub. The seropositivity was also significantly higher in those working in paddy fields and those living near the forest (P < 0.05). Conclusion: The results of the present study confirm the existence of Rickettsial diseases in this region. This data would promote awareness of rickettsioses among local physicians and will also serve as a baseline to detect changing prevalence in the future

NDM-1 (New Delhi metallo beta lactamase-1) producing Gram-negative bacilli: Emergence & clinical implications

Backgound & objectives: Resistance to carbapenems in Gram-negative bacteria conferred by NDM-1 is a global health problem. We investigated the occurrence of NDM-1 in clinical isolates of Gram-negative bacilli in a tertiary care hospital in Kashmir valley, India. Methods: Gram-negative bacilli from different clinical isolates were included in the study. Antimicrobial susceptibility was performed by Kirby Bauer disk diffusion method and interpreted using Clinical Laboratory Standards Institute (CLSI) guidelines. Isolates resistant to carbapenems were subjected to different phenotypic test such as modified Hodge test (MHT), boronic acid and oxacillin based MHT ( BA-MHT and OXA-MHT), combined disk test and minimum inhibitory concentration (MIC) with imipenem and imipenem -EDTA for determination of class B metallo enzymes. Presence of blaNDM-1 gene was established by PCR and confirmed by sequencing. Results: Of the total 1625 Gram-negative isolates received, 100 were resistant to imipenem. Of the 100 isolates, 55 (55%) were positive by modified Hodge test indicating carbapenemase production. Of the 100 isolates tested by MHT, BA-MHT and OXA-MHT, 29 (29%) isolates belonged to Class A and 15 (15%) to Class B, while 56 (56%) isolates were negative. Of the 15 class B metallo beta lactamase producers, nine carried the blaNDM-1 gene. NDM-1 was found among Escherichia coli (2 isolates), Klebsiella pneumoniae (2 isolates), Citrobacter freundii (3 isolates), Acinetobacter spp (1 isolate), and one isolate of Pseudomonas aeruginosa. Isolates were resistant to all antibiotic tested except polymyxin B and tigecycline. Interpretation & conclusions: Our study showed the presence of clinical isolates expressing NDM-1 in Srinagar, Jammu & Kashmir, India. These isolates harbour plasmid mediated multiple drug resistant determinants and can disseminate easily across several unrelated genera. To halt their spread, early identification of these isolates is mandatory

Early Detection of Antibiotic Resistance in Positive Blood Cultures: A Study from a Tertiary Care Center in India

Background and objectives: Conventional culture and sensitivity methods take around 48 hours to generate antibiotic sensitivity results after a blood culture is flagged as positive by automated systems. However, it is imperative to initiate early targeted antibiotic therapy for effective management of sepsis and to reduce morbidity, mortality, and cost of treatment. This study aimed to evaluate the direct sensitivity test (DST) as a potential tool to obtain quicker antibiotic susceptibility results from positive BacT/ALERT blood culture vials and the VITEK-2 system (the reference method). Methods: Blood culture bottles flagged as positive by BacT/ALERT were Gram-stained. Cultures with polymicrobial growth were excluded from the study. The isolates were then simultaneously cultured and processed for the DST using the disk diffusion method. Agreements or errors were interpreted according to the Clinical and Laboratory Standards Institute’s guidelines. Results: Among 76 Gram-positive isolates, we observed 99.2% essential agreement between the DST and AST. The rate of minor and major errors was 4.04% and 1.18%, respectively. Among 75 Gram-negative isolates, we observed 98.99% essential agreement between the DST and AST. The rate of minor and major errors was 4% and 2%, respectively. No very major error was seen in either Gram-negative or -positive isolates. Conclusions: The DST results are available earlier than the AST results, which can ultimately help in the early initiation of targeted antibiotic therapy

Noisy orchestra - Renal transplant and urinary tract infections

Introduction: Kidneys are the most frequently transplanted organs; renal transplantation is the preferred method for treating patients with chronic kidney disease; and posttransplantation urinary tract infection (UTI) is still a source of morbidity and graft failure. Materials and Methods: This prospective study was conducted during the period of August 2016 to February 2018. A total of 35 renal transplant recipients were included in the study. Results: The most common symptom associated with the infection was dysuria (71%). Only 66% of the cases were febrile. Almost 17% of the cases presented with shock. Urine culture was positive in 23 (65%) cases, with bacteria in 22 (96%) and fungus in 1 (4%). Predominant bacteria grown from cultures were Klebsiella pneumoniae 32%, Pseudomonas aeruginosa 18%, Escherichia coli 14%, Enterococcus faecalis 13%, Acinetobacter 10%, Staphylococcus aureus 9%, and Enterobacter 4%. Antibiotic resistance profiles showed a high resistance patterns to ceftriaxone 60%, levofloxacin 53%, nitrofurantoin 53%, ciprofloxacin 40%, cotrimoxazole 40%, piperacillin–tazobactam 26%, amikacin 26%, gentamicin 26%, meropenem 26%, and imipenem 13%. Patients were followed up over a period of 4 weeks. At the 2nd week of follow-up, 2 (5%) cases were still culture positive, and the symptoms of UTI persisted in 6 (17%) cases. Of 35 cases, 25 were followed up till the 4th week. Culture positive was noted in 6 (24%) cases, and the symptoms persisted in 10 (40%) cases. In recurrent infections, relapses were noted in 3 (50%) cases and reinfections in 3 (50%). Conclusion: In these high-risk patients, antibiotic selection, duration, and stewardship need to be readdressed. Microbial profile and sensitivity patterns in such patients are different from the usual UTIs

Genetic diversity and population genetic structure analysis of Echinococcus granulosus sensu stricto complex based on mitochondrial DNA signature.

The genetic diversity and population genetics of the Echinococcus granulosus sensu stricto complex were investigated based on sequencing of mitochondrial DNA (mtDNA). Total 81 isolates of hydatid cyst collected from ungulate animals from different geographical areas of North India were identified by sequencing of cytochrome c oxidase subunit1 (coxi) gene. Three genotypes belonging to E. granulosus sensu stricto complex were identified (G1, G2 and G3 genotypes). Further the nucleotide sequences (retrieved from GenBank) for the coxi gene from seven populations of E. granulosus sensu stricto complex covering 6 continents, were compared with sequences of isolates analysed in this study. Molecular diversity indices represent overall high mitochondrial DNA diversity for these populations, but low nucleotide diversity between haplotypes. The neutrality tests were used to analyze signatures of historical demographic events. The Tajima's D test and Fu's FS test showed negative value, indicating deviations from neutrality and both suggested recent population expansion for the populations. Pairwise fixation index was significant for pairwise comparison of different populations (except between South America and East Asia, Middle East and Europe, South America and Europe, Africa and Australia), indicating genetic differentiation among populations. Based on the findings of the present study and those from earlier studies, we hypothesize that demographic expansion occurred in E. granulosus after the introduction of founder haplotype particular by anthropogenic movements

Case Report - FUNGEMIA CAUSED BY VERTICILLIUM SPECIES IN AN IMMUNOCOMPROMISED CHILD

The incidence of fungal infections is increasing due to immunocompromised states. We report a case of fungaemia due to a rare fungus -Verticillium , in a 6 year old child diagnosed as a case of acute lymphoblastic leukaemia- L1 with high grade fever. The patient was treated with amphotericin B with a good clinical response

Multiple alignments of partial <i>cox1</i> gene sequences.

<p>Accession numbers with suffix JX and KC are the representative sequences of G1, G3, G5 and G6 genotypes and their haplotypes found in this study. Accession numbers DQ062857, M84663, M84665 and M84666 are the respective references sequences of G1, G3, G5 and G6 genotypes of <i>E. granulosus</i> retrieved from GenBank for comparison. n indicates the number of isolates detected for each haplotype.</p

Geographical distribution of the cystic echinococcosis patients.

<p>A) Map of India showing the location of three hospitals and geographical origin of cystic echinococcosis patients (in grey) analyzed in this study. B) State wise geographical distribution of 4 different genotypes of <i>Echinococcus granulosus</i> in North India. The number of collected samples for each state is indicated. J& K indicates the Jammu and Kashmir, H.P - Himachal Pradesh, Pb - Punjab, Hry - Haryana, U.K - Uttarakhand, U.P - Uttar Pradesh, Raj-Rajasthan, PGIMER-Post Graduate Institute of Medical Education and Research, SKIMS - Sher-i- Kashmir Institute of Medical sciences, IGMC- Indira Gandhi Medical College and Hospital.</p

Clinical characteristics of 32 cystic echinococcosis patients.

<p>Clinical characteristics of 32 cystic echinococcosis patients.</p