Increased resistance to Nalidixic acid and Ciprofloxacin in Salmonella isolates from the Sub Himalayan region

Background: During the last two decades, increased resistance to nalidixic acid and ciprofloxacin has become a cause of global concern. The present study was undertaken to ascertain nalidixic acid and ciprofloxacin resistance in Salmonella isolates from our region. To know the true pattern of ciprofloxacin resistance by determining the minimum inhibitory concentration (MIC) through E-test.Methods: All the Salmonella isolates recovered from blood cultures were screened for nalidixic acid resistance using 30µg disc by the Kirby Bauer disc diffusion method. Ciprofloxacin susceptibility was done both by disc diffusion and MIC using CLSI breakpoints.Results: We analysed a total of 80 Salmonella isolates during the last three years. Salmonella enterica serovar Typhi was the predominant serovar in 51 (64.8%) isolates, followed by Salmonella enterica serovar Paratyphi A comprising 28 (36.2%) isolates. Amongst the total isolates 78 (97.5%) were nalidixic acid resistant. Of these 54 (67.5%) showed intermediate susceptibility and 9 (11.2%) were ciprofloxacin resistant by the disc diffusion technique. On the contrary 29 (36.2%) had decreased susceptibility to ciprofloxacin; while a larger number 38 (47.5%) were detected resistant to ciprofloxacin on determination of MIC by the E-test.Conclusions: Screening for nalidixic acid acts as a surrogate marker to detect ciprofloxacin resistance. However, the true pattern of ciprofloxacin resistance can be determined by calculating the MIC by the E-test

Characterization and comparative analysis of ADRs of various ART regimens: experience of our medical college from Western Himalayan region

Background: It is estimated that there are 35.3 million PLHA worldwide and 1.6 million have received ART. ART is freely available in designated ART Centres. HAART (highly active antiretroviral treatment) has significantly reduced AIDS related morbidity and mortality. It involves using three different drugs from two different classes. The main challenge in prescribing HAART is ADRs associated with it affecting patient compliance and treatment outcomes.Methods: A retrospective observational study was carried out in the ADR monitoring Centre of Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India.Results: The data for ADEs was collected from 108 patients over a period of 17 months. A total of 280 ADEs were reported in 65 females and 43 males. TLE was the commonest regimen in 61 (56%) patients followed by ZLN in 37 (34%). Neurological ADRs were reported in 39.8% cases with TLE that was nearly double as reported with ZLN regimen 20.5%. Dermatological ADRs were highest with other regimens (57.4%) followed by ZLN 20.5%. Similarly the frequency of Gastrointestinal ADR was highest with other regimens. Hematological ADRs were maximum with ZLN (22.9%) followed by TLE (3.3%). Most commonly reported ADRs were dizziness (10.7%), rashes (8.2%), anorexia and dyslipidemia (6.8%), asthenia (6.4%), pruritus (6%), joint pains (4.6%), insomnia, alopecia and vomiting (4.3%), numbness or parasthesia (3.9%), hepatotoxicity (3.6%) and deranged RFTs (1.8%).Conclusions: The real burden of ADRs due to ART cannot be estimated until voluntary and mandatory reporting system of ADRs works efficiently. A structured surveillance of the pharmacovigilance system can help to overcome these hurdles to ensure compliance with ART regimens

Profile of adverse drug reactions in patients on anti-tubercular drugs in a sub Himalayan rural tertiary care teaching hospital

Background: Tuberculosis is a major public health problem, with one out of three people in the world are infected with Mycobacterium tuberculosis. The prevalence of MDR TB in India is 2-3% among new cases and 12-17% in reinfection cases. One of the reasons for MDR may be noncompliance to treatment due to adverse drug reactions. The present study was conducted to find out ADRs in patients on antitubercular treatment (ATT) under pharmacovigilance programme of India (PvPI).Methods: This was a retrospective observational study. Data was collected through voluntary reporting by health-care professionals (HCP) in standard IPC-PvPI prescribed suspected ADR reporting form and analyzed for 100 patients on ATT. Causality assessment was done using WHO causality assessment scale.Results: The maximum ADRs were reported in adults with a mean age of 40.79±16.79 years. Males (n=66) outnumbered females (n=34). There were 62% MDR-TB on DOTS-plus regimen, followed by 35% on Cat1 ATT for pulmonary and extrapulmonary tuberculosis cases and XDR-TB accounted for 3% of the total cases. The commonest ADRs in patients on MDR treatment were related to CNS 44 (27.5%), followed by Gastrointestinal system 31 (19%), psychiatric 20 (12.5%) otovestibular 13 (8%) and ophthalmic ADRs being the least in frequency 1 (0.6%). In contrast patients on Cat 1 ATT the ADRs involving Gastrointestinal system 44 (44%) followed by CNS 12 (12%), psychiatric 0% and ADRs related to otovestibular manifestations being the least 1 (1%) frequency.Conclusions: ADRs involving different organ systems were seen in both categories with varied frequency. Adverse drug reactions add to hospitalization expenses, insurance costs and increase in work loss days besides addition to patient suffering and loss of compliance. Prior knowledge can help in better prescriptions and prevent valuable resource loss

Onychomycosis due to Aspergillus niger with concomitant multiple fungal infections in a human immunodeficiency virus infected person

Opportunistic fungal infections are common in human immunodeficiency virus (HIV) infected patients and commonly occur at some point during their illness. Though estimates show that these infections can occur in HIV patients with the same frequency as in the control group, their presentations are more severe and variable in HIV/acquired immunodeficiency syndrome. We present an HIV infected case with multiple fungal infections. This patient had onychomycosis due to Aspergillus niger, tinea cruris caused by Trichophyton rubrum, oral thrush and balanoposthitis due to Candida albicans

Screening for metallo-β-lactamase producing Pseudomonas aeruginosa in clinical isolates in a tertiary care hospital in North India

Introduction: Pseudomonas aeruginosa has acquired a new metallo-β-lactamase (MBL) resistance gene responsible for increased resistance to fluoroquinolones, cephalosporins and carbapenems. Thus, it is essential to know the antibiotic sensitivity pattern and follow the antibiotic policy. Objectives: The objective of this study is to detect MBL production in clinical isolates by combined imipenem-ethylenediamine tetra acetic acid (IMP-EDTA) disc test. Materials and Methods: This study was conducted for a period of nine months from April 2011 to December 2011. A total of 66 consecutive isolates of P. aeruginosa were subjected to susceptibility testing by disc diffusion assay. IMP drug resistant strains were screened for MBL production by combined IMP-EDTA disc test. Results: Ciprofloxacin resistance was seen in 66.6% isolates followed by piperacillin in 51.5%. Resistance toward amikacin, ceftazidime, and cefoperazone were noted in 43.9%, 40.9%, and 37.8% isolates, respectively. In 37.8%, IMP resistance was observed. All IMP resistant strains (n = 25) were screened for MBL production. All the 25 isolates (100%) were MBL producers, exhibiting more than 7 mm zone size enhancement in IMP-EDTA combined disc test. Conclusion: Emergence of P. aeruginosa as MBL producer is becoming a therapeutic challenge. There is a need to implement routine antibiotic surveillance and judicious use of antibiotics

Group B streptococcal meningitis in children beyond the neonatal period in sub-Himalayan India

Objectives: To evaluate clinicolaboratory profile and the outcomes in children (1 to 59 months) diagnosed with Group B streptococcus (GBS) meningitis over a period of 1 year. Materials and Methods: Cerebrospinal fluid (CSF) samples of 250 pediatric patients (1 to 59 months) admitted with suspected acute bacterial meningitis(ABM)were subjected to cell count, biochemical profile, culture, latex particle agglutination (LPA) and polymerase chain reaction (PCR).They were also evaluated for complications and were followed-up till 6 months after discharge. Results: Forty patients (25 boys and 15 girls), 16% of total suspected cases of ABM were diagnosed with GBS by LPA method and 30 (75%) out of these were above 3 months of age. The median duration of hospital stay was 7 days (range 1 to 72 days). State of coma was observed in two (5%) and one (2.5%) died, while 20 (50%) patients recovered completely. Conclusion: GBS should be considered as an important cause of ABM in Indian children beyond the neonatal period and further studies are warranted to determine the actual problem of the disease in our country

Eleven year performance of an Integrated Counseling and Testing Center in a tertiary care hospital in Himachal Pradesh, India

Introduction: The integrated counseling and testing centre (ICTC) has proved to be an essential human immunodeficiency virus (HIV) infection prevention intervention, especially in nations where poverty, social inequality, and weak health infrastructure exist. Objectives : The study was conducted to (i) assess the performance of ICTC in a referral hospital over a period of 11 years (ii) understand the regional risk determinants of HIV-positive clients. Materials and Methods : In this record based hospital study, data from January 2000 to December 2010 of all ICTC attendees and HIV-positive clients (excluding pregnant women; surveillance in this group is being conducted routinely) was collected by reviewing the records, compiled, and analyzed. Results : A total of 19,234 clients were counseled, of which 17,411 were tested and 970 were detected positive for HIV. The HIV seropositivity amongst the total tested clients was 5.57%. The intake of clients attending ICTC consistently increased from 781 clients in 2000 to 5574 clients in 2010. Amongst the total 970 HIV positives the ratio between male and female positives was 3:2 (m = 584; f = 386). Of these, 42.1% were in the age group of 25-44 years and children (<15 years) accounted for 7.8%. The heterosexual route of transmission was documented in 77.4%. In 13.6% (n = 132) HIV-positive clients, the route of transmission was not identified. The provider initiated client visits increased significantly from 4.85% in 2006 to 82.05% in 2010 than the direct walk-in clients (P < 0.0000001). However, the HIV-positive clients were three times more in the direct walk-in clients than in the provider initiated clients (P < 0. 0000001). Conclusion : Increased utilization of ICTC reflects the overall attitudinal changes in behavior and heterosexual high risk behavior continues to be the major route of HIV transmission

Mycological pattern of dermatophytosis in and around Shimla hills

Introduction: Dermatophytosis is defined as the fungal infection of the skin, hair and nails by a group of keratinophillic fungi known as dermatophytes. Aims and Objectives: This study is an attempt to find out various species of dermatophytes in clinically suspected cases of dermatophytosis. Materials and Methods: One hundred samples were subjected to direct microscopy by potassium hydroxide wet mount (KOH) and isolation on culture with Sabourauds dextrose agar. Results: Out of these 80 (80%) samples were KOH positive while 20 (20%) were KOH negative. Overall culture positivity rate was 68%. Dermatophytosis was more common in males, the M:F ratio was 4:1. Conclusion: Total seven species were isolated on culture. Trichophyton rubrum (66.17%) was the commonest isolate followed by Trichophyton mentagrophytes (19.11%), Trichophyton violaceum (7.35%), Trichophyton tonsurans (2.94%) and one isolate each of Epidermophyton floccosum and Microsporum gypseum (1.47%)

Post Pandemic Scenario of Pandemic 2009 H1N1 and Seasonal Influenza AVirus Infection in Himachal Pradesh, India

The 2009 H1N1pandemicpresented as a public health emergency globally.This prospective study was carried out to analyze the clinical profile of seasonal and 2009 H1N1 influenza A virus infection in patients presenting with influenza like illnessfrom April 2012 to March 2013.Respiratory specimens from these patients attending the tertiary care hospital were tested for seasonal and 2009 H1N1 influenza A virus by real time reverse-transcription polymerase chain reaction.A total of 451 respiratory sampleswere tested and8.20% were confirmed positive for 2009 H1N1 and3.99%for seasonal influenza Avirus.Amongst 232 females, 8.62% and 2.15%and amongst 219 males, 7.76% and5.93% were detected positive for2009 H1N1 and seasonal influenza A virus respectively.The mean age forinfection with 2009 H1N1 Influenza A virus was 40.54 ±19.43 (2SD).Fever (86.49%;p value<0.02) and lower lobe lung involvement (84.76%; pvalue<0.006) was statistically significantwith2009 H1N1. Females were significantly affectedby 2009 H1N1 (p<0.03, c2 =2.39).Maximum number of cases occurred in winter months.Seasonal and 2009 H1N1influenza A virusare currentlyco-circulating and continuous surveillance & monitoring of influenza like illness is crucial for preparedness

Service delivery through public health care system to control sexually transmitted infections in Himachal pradesh

Introduction: The National AIDS Control Organization has designed multiple synergistic interventions to identify and control curable sexually transmitted infections (STIs). Objective: To assess the impact of services offered at designated STI clinics in the state of Himachal Pradesh, India and the profile of the attending clients. Materials and Methods: This was a two-year prospective study, conducted from April 2011 to March 2013. Training on delivering STI/RTI services was imparted to the staff of 16 designated STI clinics including recording of data. The staff in each STI clinic comprises of one doctor, one counselor, one nurse, and one laboratory technician. The clients attending these designated clinics were offered counseling, syndromic case management (SCM), and diagnostic services wherever possible. Monthly data of STI clinic attendees was collected, compiled, and analyzed. Results: A total of 65,760 clinic visits were reported, of which 32,385 (49%) visits were for index STI/RTI complaint(s). The ratio of male to female attendees was 1:2. The commonest age group accessing the STI clinics was 25-44 years (n = 38,966; 59.3%). According to SCM, 52.9% clients were managed. The commonest presenting syndrome was urethral discharge (n = 4,500; 41%) in males, and vaginal discharge (n = 13,305; 56%) in females. Genital ulcer disease was treated in 2099 cases. Laboratory tests were performed only in 6466 patients, and 39,597 antenatal mothers were screened for syphilis. Counseling services were provided to 51,298 (f = 34,804; 68%: m = 16,494; 32%) clients and of these, 48% (n = 25,056) of the clients were referred to integrated counseling and testing centers. Forty-three clients (m = 24: f = 19) were detected positive for HIV infection. Conclusion: Uniform and standardized services delivered to clients attending public health clinics can gather reliable data to monitor trends of STI infection