Utility of rapid diagnostic kit tests for diagnosis of suspected dengue fever

Background: Dengue fever often presents as an undifferentiated febrile illness requiring a laboratory test for identification. Serological tests particularly on rapid kits for the detection of NS1Antigen, IgG and IgM antibodies are the most commonly performed test across the country.Methods: The serum samples of suspected dengue cases were tested by Rapid test kits for assessing all the three parameters as well as by ELISA for NS1 antigen test. The platelet count of the patients was obtained from automated coulter counter. The results thus obtained were analyzed in Excel format.Results: The serum samples from 304 suspected Dengue fever cases were received in the lab, of which 190 samples were positive either by rapid or ELISA and 176 when rapid card test was considered alone Highest seropositivity of dengue cases were observed in the age group of ≥60 years (79.2%) followed by 45-59 years (70.7%). On rapid test, 78 cases were NS1 antigen positive of which 60 cases were positive only for NS1 antigen. When NS1 rapid and ELISA tests when compared, 16 kit negative tests were positive on ELISA while 34 kit positive tests were ELISA negative.  Sensitivity, specificity, PPV and NPV when only NS1 was considered on rapid test kits when compared with ELISA were 78.9%, 87.8%, 63.8% and 93.8%. 33.5% of serologically positive cases of Dengue had low platelet count on admission while only among negative cases 17.2% had a low platelet.Conclusions: Rapid kits often show variable results thus needing a validation of them from end user. As a positive dengue test result is an essential prerequisite for diagnosis thus it is essential that for serological tests ELISA technique should be used for reporting. Thus, it also mandates more efforts at decentralization of NVBDCP to include both government and non government institutions

Streptococcus pseudoporcinus: a rare cause of bacteraemia in an immune-compromised patient

Streptococcus pseudoporcinus, a ß-haemolytic Streptococcus is known to cause genital infections. Author report a rare case of Streptococcus pseudoporcinus bacteremia in an immune-compromised male patient diagnosed with acute myeloid leukemia eight months back. The organism was identified as a beta hemolytic bacterium which was catalase negative, oxidase positive and bacitracin resistant. Automated methods (VITEK-2) confirmed the organism to be Streptococcus pseudoporcinus

Microbiological analysis of urinary tract infection in diabetic patients

Background: Diabetes mellitus is a predisposing condition to different infections especially the complicated urinary tract infection (UTI). The susceptibility pattern of organisms in diabetics is different from their counterparts. So, there is always a dilemma while administering empirical regimen for UTI in diabetics. The study aims to find the common organisms implicated in the UTI in diabetic patients and their sensitivity pattern.Methods: Properly collected urine specimen from all the diabetic (cases) and non-diabetic (controls) patients included in this study was processed. Sensitivity pattern and extended spectrum beta lactamase (ESBL) production for the isolated uropathogens was noted.Results: E. coli was the most common organism isolated from both 68 cases and 85 controls in this study. Most of UTI patients with diabetes, 46 (67.7 %) had uncontrolled blood sugar level. Diabetics are more prone for catheter associated UTI (CAUTI) and fungal UTI. Most of the E coli and Atypical E coli isolated were ESBL positive for the diabetic patients (60.5%) than that for the non-diabetics (40.4%). Antimicrobial resistance pattern was similar in both the groups with maximum patients’ sensitivity to tigecycline, colistin, fosphomycin and least susceptibility to cefixime. Both E. coli and Klebsiella also showed high resistance to the fluoroquinolones.Conclusions: E. coli is the predominant uropathogen for both the diabetic & non-diabetic cases. But diabetics are more prone to get ESBL positive UTI. CAUTI and the fungal UTI are more common in diabetics. Diabetic condition does not affect the antimicrobial resistance pattern of uropathogens. But their rising resistance to fluoroquinolones, cephalosporins is a matter of concern while prescribing empiric regimen

Microorganisms causing wound infection and their antibiotic susceptibility pattern

Background: Pyogenic infection is one of major causes of morbidity and increasing medical expense. Multiple organisms can cause wound infection. Drug resistant bacteria are the most important therapeutic challenge.Methods: A prospective study was carried out from July 2021 to October 2021and pus samples were collected from suspected OPD and indoor patients with wound infection. The pus specimen after appropriate aerobic culture, the bacteria grown was identified by colony morphology, staining reaction and different standard biochemical tests. Modified Kirby Bauer disc diffusion method was used for the antimicrobial susceptibility testing.Results: Out of 140 pus samples from wound infection of suspected patients, 88 (62.9%) showed bacterial growth and most of them were from male patients, 66 (64.70%). Most of the isolates were isolated from in-patient (52, 59.1%). Staphylococcus aureus was the most prevalent pathogen (38.6%) followed by Klebsiella spp. (22.7%). Most of the S. aureus were MRSA (32.4%) and sensitive to vancomycin, linezolid and teicoplanin. Klebsiella spp. and other Gram-negative bacteria isolates were mostly sensitive to imipenem and they were highly resistant to co-trimoxazole, cephalosporins.Conclusions: The organisms mainly attributing for pyogenic wound infections are S. aureus, Klebsiella species. High level of drug resistance was seen for both Gram positive and Gram-negative bacteria. Continuous surveillance is necessary. As the microorganisms isolated were mostly resistant to different antibiotic classes, so effective surveillance and proper implementation of local antibiotic policy is needed.

Prevalence of nasal carriage of MRSA in diabetic patients attending the outpatient department

Background: Up to 30% of the human population is asymptomatically colonized with nasal Staphylococcus aureus. Study was done to determine the prevalence and risk factors for MRSA colonization as nasal carrier in a population of outpatients with diabetes.Methods: The study enrolled patients with diabetes from whom nasal swabs were obtained and were analyzed for presence of MRSA.Results: Out of the 402 patients evaluated, 254 (63.18%) were colonized with S. aureus and 164 (64.56%) of them were MRSA.Conclusions: Diabetes have more propensity for MRSA colonization than non-diabetic patients. A better understanding of the epidemiology and risk factors for nasal MRSA colonization in the persons with diabetes may have significant implications for the treatment and prevention of MRSA infections

Epidemiological and Microbiological Study of Onychomycosis

Introduction: Onychomycosis is a common fungal infection of nail. It may be caused by dermatophytes, non-dermatophytic moulds or yeasts involving nail bed, nail plate or matrix of nail. As the fungi show variable susceptibility to antifungal drugs and treatment requires long duration of antifungal therapy, so it’s prevalence as well as proper laboratory diagnosis and antifungal susceptibility testing is essential for effective therapy. Aim: To find the prevalence of onychomycosis with demography along with various aetiology and the suitable antifungal drugs used for treatment. Materials and Methods: For this prospective study, over a period of two years a total of 300 nail samples were processed in the Department of Microbiology at IMS and SUM Hospital, Bhubaneswar, Odisha, India. The wet mount for microscopic examination was prepared using 20% Potassium Hydroxide (KOH) and examined after overnight incubation. Culture was done in duplicate in Sabouraud’s Dextrose Agar (SDA) tubes; one with actidione and another without it and both were incubated at 25°C in Biological Oxygen Demand (BOD) incubator. Culture tubes growing yeasts were further subjected to speciation by germ tube test, culture on Chromogenic (CHROM) agar and on cornmeal agar. In-vitro antifungal susceptibility testing was performed against Candida species using disc diffusion method on Muller Hinton agar. Chi-square test was used for statistical analysis of the results. Results: Onychomycosis can affect a wide age group though seen commonly at 31-40 years equally in both male and females. Fingernail infection was observed mostly in female cases. It was caused by Candida species (66%), moulds (24%) and dermatophytes (10%) and out of Candida sp. C.albicans was the main culprit. Although all the Candida strains were susceptible to amphotericin B, still some of them showed resistance to the commonly used antifungals like fluconazole and itraconazole. Conclusion: Candida albicans was the most common aetiological agent which contributed for onychomycosis and showed a variable resistance pattern to the commonly used antifungals. Proper laboratory diagnosis and selection of antifungal drug is essential prior to institution of therapy for successful treatment of this disease

Prevalence and Resistance Pattern of Uropathogens in Pregnant Women- A Cross-Sectional Study

Introduction: Urinary Tract Infection (UTI) is the most common medical problems associated with pregnancy occurring in about 5-10% of pregnant women. It is attributed by various micro- organisms. As the uropathogens is usually Multidrug resistance so, timely identification of these uropathogens and their resistance pattern detection is essential. If UTI is not treated promptly, it can lead to various complications and ultimately can affect health of infant or the pregnant mother. Aim: To estimate the frequency of UTI and different micro- organisms in pregnant women as well as their antibiotic resistant pattern among them. Materials and Methods: Present study was conducted in a tertiary care hospital in rural district of Chhattisgarh. During the study period from August 2021 to October 2021, 130 urine samples were collected and processed as per standard protocol. With significant growth on culture ≥105 Colony Forming Unit (CFU)/mL of single morphotype bacteria from a clean catch midstream urine sample UTI diagnosis was established. The bacteria isolated were identified up to species level by standard biochemical tests. Results: In this study, UTI was found in n=69.2% of pregnant women. The most frequently isolated organism was E. coli (53.3%), followed by Klebsiella spp.(18.9%) and Pseudomonas spp. (3.3%). Highest prevalence rate (85.7%) was observed in the age group 21 to 25 years; most of these (77.8%) were in their 2nd trimester. The isolated pathogens mostly showed multiple drug resistance to two or more antibacterial agents tested. Conclusion: There was higher incidence of UTI in pregnancy and the most predominant organism isolated was E. coli; in 2nd trimester UTI was more common and high level of multidrug resistance was observed. In pregnancy, continuous monitoring of uropathogens including their resistance pattern is required

Aerobic bacteriology of burn wound infections

Introduction: Burn wound infections are important cause of mortality, morbidity and prolonged hospitalization in burn patients as the causative agent is generally a multidrug resistant organism. The pattern of microbial flora infecting burn wound varies according to geographical pattern as well as with duration of hospital stay. Objective: The present study aims to identify the causative agents of burn wound infections in our hospital, to assess the change in pattern of flora in accordance to duration of wound as well as to determine the sensitivity pattern of isolates. Materials and Methods: Wound swabs from 52 patients admitted in Burn unit of IMS and SUM Hospital, Bhubaneswar were collected every 5th day during their hospital stays and were cultured. The results were interpreted according to the standard methods and antibiotic susceptibility pattern was noted. Results: The most common organism isolated was Staphylococcus aureus, that is, 20 (47.6%) while Klebsiella spp. 12 (28.6%) was the most common Gram-negative isolate. The commonest organism isolated in the 1st week of hospital stay was S. aureus (15.4%), but it was Acinetobacter spp. (22.2%) in 2nd week and coagulase negative Staphylococcus in 3rd week of hospital stay S. aureus was mostly sensitive to levofloxacin (77.8%) and netilmycin (98%). Conclusion: The pattern of bacterial flora changes according to duration of hospital stay. Effective strict isolation techniques and infection control are thus needed to decrease the occurrence of burn wound infection