A study on antimicrobial sensitivity pattern in Neisseria gonorrhoeae in a tertiary care hospital

Background: Sexually transmitted diseases are prevalent throughout the world. Sexually transmitted diseases (STD) play a major role in the transmission of HIV infection. The risk of acquiring HIV infection in non-ulcerative STD is 3 to 5 times more than that in persons without any sexually transmitted infections. One of the main non-ulcerative STD is gonorrhoea. The relative incidence of gonococcal infections is about 10 to 13% of total sexually transmitted infections in STD clinics. Aims and objectives was to identify gonococcal infection in patients attending the STD clinic and associated sexually transmitted infections and to study the antimicrobial susceptibility of gonococcus and to modify the disease intervention strategies.Methods: A retrospective study was conducted in our institute of venereology, government general hospital and madras medical college, Chennai-03, Tamil Nadu, India. 43 patients with gram stained smear or culture positive for gonococcus who attended the institute from February 2013 to September 2014 were taken into the study. All the details were collected from the case records of the patients. The antibiotic sensitivity testing in N. gonorrhoeae had been done by Kirby-Bauer disc diffusion method. Screening for other sexually transmitted diseases had been done and were treated according to the institute guidelines.Results: Specimens from 43 patients (40 male, 3 females) had been collected. 40 specimens were found to be culture positive. Antibiotic sensitivity tests were carried out on those 40 isolates of Neisseria gonorrhoeae obtained in pure culture. 70% of isolates were resistant to penicillin and 30% were less sensitive to it. 52.5% of the isolates were PPNG. 57.5% of isolates were resistant to ciprofloxacin and 42.5% were less sensitive to it. 7.5% were resistant to ceftriaxone, 12.5% were resistant to cefixime and 15% were resistant to spectinomycin. All the isolates were sensitive to Azithromycin. Three male patients had HIV (6.9%), three had syphilis and one had genital wart. One female patient had trichomoniasis.Conclusions: The results of the study indicate that multidrug resistant Neisseria gonorrhoeae is prevalent in this region. Associated STDs must be investigated to prevent the transmission of HIV and further complications. The need for establishing a national surveillance programme for antibiotic resistance becomes clear with this study

Study of antimicrobial sensitivity pattern of neisseria gonorrhoeae.

INTRODUCTION : Sexually transmitted diseases are prevalent through out the world. About 340 million new cases reported every year. Incidence of new STD cases per year in India is about 40 million or 5% of population. Globally around 39.4 million person are living with HIV/AIDS, and India has 5.13million HIV infections.1 Sexually transmitted diseases (STD) play a major role in the transmission of HIV infection. Thus prevention and control of STD is one of the major strategies for the control of HIV. STD can be grouped as ulcerative and non-ulcerative. The risk of acquiring HIV infection in ulcerative STD is 5 to 7 times and in non ulcerative STD to 3 to 5 times more than that in persons without any sexually transmitted infections. Since the prevalence of non-ulcerative STD is higher than ulcerative STD, it represents the population at attributable risk in the transmission of HIV. One of the main non- ulcerative STD is Gonorrhoea. The relative incidence of gonococcal infections is about 10 to 13% of total sexually transmitted infections in STD clinics. Common symptoms are urethritis in male and cervicitis is female. HIV positive men with urethritis had HIV concentrations in the semen more than those in seropositive men without urethritis. After treatment of urethritis the concentrations of HIV in semen decreased significantly. Causative organism for gonorrhoea is Neisseria gonorrhoeae. Man being the only natural host. N. gonorrhoeae usually produces purulent exudates, but signs and symptoms of the disease may be absent especially in women or indistinguishable from those of Chlamydial infection. Therefore, laboratory procedures are needed for the diagnosis. In recent years, there has been an alarming increase in ciprofloxacin and penicillin-resistant N. gonorrhoeae in India. Establishing appropriate treatment strategies is further complicated by the rapidly changing resistance patterns. Hence monitoring of drug resistance patterns at regular intervals, is essential. AIMS AND OBJECTIVES : 1. To identify the gonococcal infection in patients attending the STD clinic. 2. To study the antimicrobial susceptibility of gonococcus. 3. To study the prevalence of Penicillinase producing N. gonorrhoeae. 4. To study the associated sexually transmitted infections. 5. To modify the disease intervention activities and therapy recommendations accordingly. PURPOSE OF THE STUDY : The knowledge of the prevalence of antibiotic resistant strains is essential for instituting disease control and preventive measures. In India we do not have enough data about the prevalence of antibiotic resistant strains. Efforts are being made to widen the SEAR GASP (South East Asia Region Gonococcal Antimicrobial surveillance programme) network in India. Treatment recommendations has to be changed depending upon the surveillance data. WHO no longer recommends a single, first line treatment for gonorrhoea. Instead each nation must make decisions according to its own resistance situation as resistance levels vary from one nation to the next indeed from clinic to clinic. CONCLUSION : 1. The results of the study indicate that multidrug resistant Neisseria gonorrhoeae is prevalent in this region. 2. The value of Penicillin and Ciprofloxacin as drugs for the treatment of Gonorrhoea is doubtful as all the strains were either less sensitive or resistant to these drugs. 3. Azithromycin looks promising with no drug resistance. 4 Associated STDs has to be investigated to prevent the transmission of HIV and further complications. 5. Need for establishing a national surveillance programme for antibiotic resistance becomes clear

Seborrhoeic keratosis with autosomal dominant inheritance - a rare case report

Seborrhoeic keratosis is a benign tumour composed of epidermal keratinocytes, displaying varying morphological features, frequently pigmented and more common in the elderly. Various clinical and histopathological variants have been described. A genetically determined predisposition to Seborrhoeic keratosis is largely accepted. We report a case of multiple Seborrhoeic keratoses of childhood onset and transmitted for three generations in her family members as an autosomal dominant trait

Basal cell carcinoma- a prospective clinico epidemiological and pathological study

Background: Basal cell carcinoma is the most common malignant tumour of the skin worldwide. The objective was to find out the age and sex incidence of basal cell carcinoma in patients attending the outpatient department of dermatology and to find out the various clinical and histopathological features of basal cell carcinoma.Methods: It was a prospective observational study carried out in a tertiary care hospital, Chennai, Tamilnadu, India. Patients with clinical diagnosis of basal cell carcinoma were included in the study after thorough history, clinical examination, routine and special investigations like skin biopsy.Results: Out of 20 patients with basal cell carcinoma 6 were males and 14 were females with a male to female ratio of 1:2.33. Most commonly affected age group was 50-70 years (70%). Distribution of BCC in our study was confined to head and neck area. Most common morphological subtype encountered in this study was nodular/nodulo-ulcerative BCC (70%), followed by pigmented type (25%) and superficial BCC (5%). The most common histological variant observed in present study was nodular type (55%), followed by pigmented variant (25%), adenoid (5%), basisquamous (5%), superficial BCC (5%) and BCC with sebaceous differentiation (5%).Conclusions: This study highlights a paradoxically increasing trend of BCC with female predilection. Early detection and treatment of lesions are crucial to decrease the functional and cosmetic disfigurement and also this study highlights the importance of improving awareness among general practitioners, public health workers and general population

Clinico-epidemiological study of stasis eczema

Background: This study was done to determine the epidemiological aspects of stasis eczema and the association of various risk factors of the disease in the local population.Methods: This cross-sectional study was done at a tertiary hospital in southern India over a period of 1 year. Epidemiological and clinical data of stasis dermatitis patients above 20 years of age were recorded. Data was tabulated and analyzed using Microsoft excel software.Results: Of the study population of 120 prevalence is found to be highest in the age group of 50 to 60 years (42.5%) and males are more commonly affected. Occupation involving prolonged standing or sitting and lack of exercise activity is found to be a significant risk factor. The commonest skin finding in present study is eczema (80%). The most common complication was ulcer which was seen in 12.5% of our patients. Reticular veins are the most common dilated veins seen in our patients. About 70% of patients in present study fall under C4a stage of CEAP classification. About one half of symptomatic patients in present study (53.3%) had no radiological evidence of incompetent veins. Among patients with valvular incompetence, perforator veins were most commonly found to be incompetent (62.5%) followed by involvement of the saphenous venous system (23.2%).Conclusions: The study confirms the importance of environmental factors in the development of stasis eczema. There is a ten-fold higher prevalence of the disease in men in our population compared to previous studies which invariably reports a female preponderance