Hemophagocytic lymphohistiocytosis secondary to infections:a tertiary care experience

Background: Hemophagocytic lymphohistiocytosis is an uncommon complication of various conditions. It is characterized by immune dysregulation and massive cytokine release causing multiorgan dysfunction. It is classified as primary and secondary to various etiologies like infections, malignancies and autoimmune disease. As it has high mortality, clinician awareness is important for early diagnosis and improved outcome. Aim of the study was to study the etiologies, clinical manifestations, complications and laboratory features in patients diagnosed with infection associated hemophagocytic syndrome (IAHS).Methods: We have done retrospective analysis of all cases diagnosed to have Infection Associated Hemophagocytic Syndrome (IAHS) between March 2012 to November 2015 in a 1000 bedded tertiary care hospital in south India.Results: Total five cases detected. Most of the cases are related to tropical infections (80%). All of them presented with fever, cytopenias and organomegaly. Ferritin and Triglycerides were elevated in all patients. Bone marrow hemophagocytosis was observed in 80% of cases. Diagnostic protocol of HLH 2004 was followed. Only 20% survival observed.Conclusions: IAHS is a rare fulminant complication associated with diagnostic and therapeutic challenges because of overlapping clinical features with sepsis. Increased physician awareness, early diagnosis and therapeutic interventions may improve survival

A Toolbox for Tuberculosis Diagnosis: An Indian Multicentric Study (2006-2008): Microbiological Results

BACKGROUND: The aim of this multicentric prospective study in India was to assess the value of several microbiological tools that contribute to the diagnosis of tuberculosis (TB) according to HIV status. METHODS: Standard microbiological tools on individual specimens were analyzed. RESULTS: Among the 807 patients with active TB, 131 were HIV-infected, 316 HIV-uninfected and 360 had HIV-unknown status. Among the 980 non-active TB subjects, 559 were at low risk and 421 were at high risk of M. tuberculosis (Mtb) exposure. Sensitivity of smear microscopy (SM) was significantly lower in HIV-infected (42.2%) than HIV-uninfected (75.9%) (p = 0.0001) and HIV-unknown pulmonary TB patients (61.4%) (p = 0.004). Specificity was 94.5% in non-TB patients and 100% in health care workers (HCW) and healthy family contacts. Automated liquid culture has significantly higher diagnostic performances than solid culture, measured by sensitivity (74.7% vs. 55.9%) (p = 0.0001) and shorter median time to detection (TTD) (12.0 vs. 34.0 days) (p = 0.0001). Specificity was 100% in HCW and cured-TB patients, but was lower in non-TB patients (89%) due to isolation of Mycobacteria other than tuberculosis (MOTT). TTD by both methods was related to AFB score. Contamination rate was low (1.4%). AccuProbe hybridization technique detected Mtb in almost all culture-positive specimens, but MOTT were found in 4.7% with a significantly higher frequency in HIV-infected (15%) than HIV-uninfected TB patients (0.5%) (p = 0.0007). Pre-test classification significantly increased the diagnostic value of all microbiological tests in pulmonary TB patients (p<0.0001) but to a lesser degree in extrapulmonary TB patients. CONCLUSIONS: Conventional microbiological tools led to results similar to those already described in India special features for HIV-infected TB patients included lower detection by SM and culture. New microbiological assays, such as the automated liquid culture system, showed increased accuracy and speed of detection

Process Evaluation of Recombinant Chitin Deacetylase Expression in E. Coli Rosetta pLysS Cells using Statistical Design of Experiments

Abstract Chitin is a natural polymer with N-acetylglucosamine units, extracted from seafood waste as a major source. It remains an underexplored polymer due to its crystalline structure. The commercial applicability can be improved if we could make it soluble. One of the routes employed to decrease this crystallinity is the conversion of chitin to chitosan via deacetylation. The industrial production of chitosan uses chemical methods, which leaves the process footprint on the environment. The greener alternative approach to producing chitosan is using chitin deacetylases (CDA). The enzymatically converted chitosan with known characteristics has a wide range of applications, importantly in the biomedical field. In the present paper, we report heterologous expression of CDA from a marine moneran; Bacillus aryabhattai B8W22. The process and the nutritional conditions were optimized for the submerged fermentation condition of E. coli Rosetta pLysS expressing the recombinant CDA using the design of experiment tools. The employment of central composite design (CCD) resulted in a ~2.39 fold increase in the total activity of expressed CDA with the process conditions of induction temperature at 22 ºC, agitation at 120 rpm, and 30 h of fermentation. The nutritional conditions required for the optimized expression were 0.061% glucose concentration and 1% lactose in media. The employment of these optimal growth conditions could result in cost-effective large-scale production of the lesser-explored moneran deacetylase, embarking on the greener route to produce biomedical grade chitosan.</jats:p