Characterization of Pseudomonas aeruginosa isolated from chronically infected children with cystic fibrosis in India

BACKGROUND: Pseudomonas aeruginosa is the leading cause of morbidity and mortality in patients with cystic fibrosis (CF). With chronicity of infection, the organism resides as a biofilm, shows multi-drug resistance, diversifies its colony morphology and becomes auxotrophic. The patients have been found to be colonized with multiple genotypes. The present work was carried out to characterize P. aeruginosa isolated from children with cystic fibrosis using phenotypic and genotypic methods. RESULTS: We studied 56 patients with CF attending the Pediatric Chest clinic at All India Institute of Medical Sciences, New Delhi, India during August 1998-August 2001. These patients were regularly followed up at the clinic. Out of 56 patients, 27 were culture positive for P. aeruginosa where 8 were chronically infected (Group1) and 19 were intermittently colonized with the organism (Group2). Patients under Group1 had significantly higher rates of hospitalization, death and colonization with different colony morphotypes (p < 0.05). The isolates from Group1 patients were the positive producers of extended spectrum beta lactamase. A total of 5 auxotrophs were recovered from 2 patients where one was chronically infected with P. aeruginosa and the other was a recently enrolled patient. The auxotrophs had the specific requirement for methionine and arginine. Molecular typing revealed 33 ERIC-PCR (E1-E33) and 5 PCR-ribotyping (P1-P5) patterns. By ERIC-PCR, 4 patients were colonized with 2–4 genotypes and the remaining 23 patients were colonized with the single genotype. CONCLUSION: With chronicity of infection, P. aeruginosa becomes multidrug resistant, diversifies its colony morphology, acquires mucoidity and shows auxotrophy for amino acids. The chronically infected patients can be colonized with multiple genotypes. Thus in a particular clinical set up, high index of suspicion should be there for diagnosis of CF patients so as to prevent the delay in diagnosis and management of CF patients

Perspective of self-help groups, Panchayati Raj institution and adolescents on implementing COVID appropriate behavior in the community in rural settings

The vaccination drive in India brought cheers to the country's people, only to be eroded by the unpredictable twitch of the COVID-19 second wave. The best way to tackle the pandemic has been to adopt appropriate practices, thereby breaking the chain of transmission. The second wave in India has already created havoc both on the people and health system, questioning and challenging our capabilities to handle any heave of sudden cases, particularly in rural areas. Time has arrived to inflate our horizon by including groups of society close to the people, particularly in the rural community. Like the previous wave, COVID appropriate behavior was very much instrumental in slowing the pace. Adolescents’ self-help groups in coalition with Panchayat Raj Institutions (PRI) will be the main stand in the fight against the dreadful virus. Their main role is to translate the prevailing preventive measures into action among the very people they live around. Passing the right message through IEC/BCC to the right people will bring about dramatic changes in the attitude, belief, and exercise they do in their day-to-day life. PRIs members would utilize their powers to execute optimum administrative services. A decentralized approach involving these stakeholders will spearhead the fight against the pandemic. This trifold power shall bear the torchbearer in preventing the disastrous consequences of any upcoming wave, if any, in a holistic manner

Pharmacotherapeutic Options for Visceral Leishmaniasis—Current Scenario

Visceral leishmaniasis (VL) or Kala-azar is a protozoal disease, which was previously regarded as one of the most neglected tropical diseases. Management of this disease is quite difficult, because it is said to affect the poorest of the poor. Previously Sodium Stibogluconate (SSG) was regarded as the gold standard treatment for VL. But due to the increasing unresponsiveness, to this drug various other drugs were tried and are still being tried. Pentamidine is very toxic and has been discarded of late. Amphotericin B and its lipid formulations are very effective but require hospital admission and monitoring. Oral drugs like Miltefosine have already been launched. An amino glycoside Paromomycin and another oral drug Sitamaquine are in the pipe line. Interferon gamma has been used with discouraging results

A case of bilateral empyema with pericardial effusion caused by streptococcus intermedius in an immunocompetent patient

Streptococcus intermedius, a member of the Streptococcus anginosus group and a part of the human oropharyngeal microbiome, is a&nbsp;recognised pathogen, mostly in immunocompromised patients or post gastrointestinal surgery, known to cause suppurative metastatic&nbsp;abscesses. We present an unusual case of bilateral empyema with pericardial effusion caused by Streptococcus intermedius in a&nbsp;healthy 30-year-old adult male patient with no known predisposing factors.This case report illustrates the ability of S. intermedius to&nbsp;produce life-threatening empyema in a healthy adult without any predisposing factors

Multidrug Resistant Bacteria Causing Nosocomial Urinary Tract Infection in Neurology/ Neurosurgical Unit of a Tertiary Care Hospital

Introduction: Nosocomial infections with the multidrug resistant microorganisms remain the major concern in the hospitalized patients. Due to the underlying illness, trauma, various neurosurgeries, patients admitted to neurology/ neurosurgery units become more vulnerable to acquire device associated infections during their hospital stay. Objectives: To study the spectrum of uropathogens and their antimicrobial susceptibility pattern among patients admitted to the neurology/neurosurgery unit. Material and methods: A prospective study was conducted in the bacteriology laboratory, Department of Microbiology over a period of 4 months. Urine samples from the patients admitted to neurology and neurosurgical unit (ward and ICU) were processed and identified as per the standard protocol. The antimicrobial susceptibility testing was done using Kirby- Bauer method as per CLSI 2014 guideline. Results: Majority of the urinary isolates belonged to Enterobacteriaceae family in both ward and ICU patients. Among these, 91 out of 106 (86%) isolates in the ward and 43 out of 51 (84%) isolates in ICU were found to be multi drug resistant. Nitrofurantoin was observed to be resistant in more than 75% of both ward and ICU isolates. Conclusion: Majority of nosocomial uropathogens were found to be multidrug resistant. This study emphasizes the emergence of MDR isolates and nitrofurantoin resistance among the nosocomial uropathogens

Tuberous sclerosis with visceral leishmaniasis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Visceral leishmaniasis, a tropical infectious disease, is a major public health problem in India. Tuberous sclerosis, a congenital neuro-ectodermosis, is an uncommon disease which requires life long treatment.</p> <p>Case presentation</p> <p>A 15-year-old Indian patient, presented to the outpatient department of our institute with a high-grade fever for two months, splenomegaly and a history of generalized tonic-clonic convulsions since childhood. The clinical and laboratory findings suggested visceral leishmaniasis with tuberous sclerosis. The patient was treated with miltefosine and antiepileptics.</p> <p>Conclusion</p> <p>The patient responded well and in a follow up six months after presentation, she was found free of visceral leishmaniasis and seizures. Diagnosis and treatment of this rare combination of diseases is difficult.</p

Identification of Clinical Immunological Determinants in Asymptomatic VL and Post Kala-azar Dermal Leishmaniasis Patients

Background: Visceral Leishmaniasis (VL) caused by protozoa belonging to the genus Leishmania, usually have anthroponotic mode of transmission and is issue of great public health importance in Indian subcontinent. Asymptomatic cases of VL and PKDL are subject of keen interest to find their role in the transmission of VL in epidemic areas. We evaluated the immunological cytokine determinants expressed in most clinical suspects of asymptomatic VL and PKDL (IL-10, IFN-γ, and TNF-α). Methods: Eighty-four participants were included at RMRIMS, Patna, India in 2016-17 out of which 64 asymptomatic individual positive for rK-39, without sign and symptoms of VL; 15 PKDL patient’s with past history of VL and 5 endemic healthy subjects were recruited from VL endemic areas. DAT and quantitative assessment of plasma cytokines was determined from the blood samples collected in a plain and sodium-EDTA vacutainer respectively from the subjects. Results: The mean level of IL-10 in DATposLOW of asymptomatic VL and PKDL was significantly higher than endemic healthy (P<0.05). The cytokine polarization index (IFN-γ versus IL-10) was significantly low in PKDL cases compared with asymptomatic VL cases in DATposLOW titre (P<0.05). This index was low again but statistically not significant in PKDL than in asymptomatic VL when TNF-α was considered against IL-10. The ratio of IFN-γ: IL-10 and TNF-α: IL-10 was observed decreased both in asymptomatic VL and PKDL cases than in healthy from endemic areas. Conclusion: Collectively we surmise from our data that asymptomatic VL can also play an important role like PKDL in transmission of VL

Polymerase chain reaction as a diagnostic tool in human viral myocarditis

Viral myocarditis is now acknowledged as a leading cause of morbidity as well as mortality in cardiovascular diseases. Its treatment is highly dependent on its proper diagnosis as its clinical features overlap with or mimic many other cardiovascular conditions. Histology by endomyocardial biopsy (EMB) confirms its diagnosis but given its own limitations and complications, the noninvasive imaging methods such as echocardiogram and magnetic resonance imaging as well as the molecular techniques like polymerase chain reaction (PCR) have redefined the entire scenario. Of these, PCR can detect the viral epitopes in peripheral blood samples, heart biopsy tissues samples, or urine/stool sample. Moreover, the best use of PCR is exemplified in the EMB samples where scarcity of the sample is not a limiting factor unlike histopathological examination. Detecting the subclinical infections, identifying different strains, and detecting pathogens which are otherwise difficult to grow gives PCR an edge. As it is said “time is money,” thus rapid detection of specific nucleic acid sequences from minute samples, and the overall cost-effectiveness makes PCR a technique of choice in the diagnostic armamentarium

Genexpert technology: A new ray of hope for the diagnosis of tuberculour pericardial effusion

Tuberculous pericardial effusion is a well-known complication of tuberculosis (TB). However, the greatest challenge in front of clinicians is its diagnosis as the conventional methods lack the required sensitivity and specificity of detection. The emergence of drug resistance and co-infections such as human immunodeficiency virus further complicates the situation making it difficult to diagnose such cases. GeneXpert technology is a major breakthrough in the field of TB diagnosis and has opened newer avenues for many new molecular tests to be launched in the future. The World Health Organization endorsed this technology in 2010 for rapid and simultaneous detection of Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance. GeneXpert-MTB/RIF assay was highly recommended as an initial diagnostic platform in high burden countries for early and quick detection of TB cases. Until date, very few studies have evaluated the performance of this brilliant assay in pericardial effusion cases, thus, more studies are required to address the unanswered questions left so far. Our review attempts to recapitulate the achievements, the potential impacts and the prospective use of this novel technology in early diagnosis of TB, especially focussing pericardial effusion cases