Is fumigation enough for air conditioning units in operation theatres and Intensive care units?

Background:Strict asepsis is necessary in operating theatres (OT) and intensive care units (ICU) as the patients undergo invasive procedures. The filters of contaminated air conditioning (AC) units provide a niche for proliferation of fungi and production of fungal spores.Methods: The routine procedure for maintenance of sterile atmosphere in our hospital, i.e. fumigation and mopping walls with disinfectants often fail to address these fungal spores of the AC filters. We therefore carried out a surveillance of the ACs in ICUs and OTs to find the level of contamination with fungal spores and also to improvise on intervention strategies to tackle the problem. Over 3 months period, 34 ACs from 7 OTs and 2 ICUs were screened by taking 2 swabs from each AC which were then tested for the presence of fungal spores as per standard methods.Results: The contamination rate was 88.2% before fumigation and 76.9% after fumigation. The fungal spore contamination rate was reduced to 20% (1 out of 5 ACs) after servicing of the ACs was done. Aspergillus spp. was the most common fungal isolate.Conclusion: Based on the observations, we recommend regular servicing of the ACs as well as wet mopping of the ducts with sporicidal solution at regular intervals.

Clinical and bacteriological study of neonatal septicaemia in a tertiary care hospital

Background: Neonatal sepsis is a clinical syndrome of bacteraemia characterized by systemic signs and symptoms in the first month of life. It is the leading causes of neonatal mortality and morbidity. Early diagnosis and treatment with appropriate antibiotics is important to improve the prognosis of neonatal sepsis. Our objectives were to study the organisms causing neonatal septicaemia, associated risk factors, to correlate CRP with blood culture and to study mortality rate in neonatal septicaemia.Methods: The study of 2 years included clinically suspected cases of neonatal septicaemia admitted in NICU. 566 blood samples were collected, processed and isolates were identified. Maternal and neonatal risk factors were studied. CRP test was done by slide agglutination test.Results: Blood culture was positive in 205 (36.22%) cases. Among the culture positive cases, 128 (62.44%) were males and 77 (37.56%) females with male to female ratio of 1.66:1. Early onset sepsis was present in 137 (66.83%) and late onset sepsis in 68 (33.17%) cases. 107 (52.20%) were low birth weight babies. The most common neonatal risk factor was prematurity 75 (36.58%) and maternal risk factor was prolonged rupture of membrane 65 (31.71%). gram negative bacilli 144 (70.24%) were found to be common cause of sepsis than gram positive cocci 61 (29.76%), Klebsiella pneumoniae 54 (26.34%) being most common pathogen. Out of 566, CRP test was positive in 244 (43.10%) cases. Mortality rate was 23.41%.Conclusions: Neonatal septicaemia is a life-threatening emergency. The study of etiological profile and CRP test plays a significant role

Emergence of multi-drug resistant strains among bacterial isolates in burn wound swabs in a tertiary care centre, Nanded, Maharashtra, India

Background: Infection is a major cause of morbidity and mortality among burn patients. The worldwide emergence of antimicrobial resistance among a wide variety of burn wound pathogens, particularly nosocomial isolates, limits the available therapeutic options for effective treatment of burn wound infections. The study was conducted in the department of Microbiology, Dr. S.C.G.M.C, Nanded, Maharashtra, India to determine aerobic bacterial isolates from burn wound swabs and describe their antibiogram.Methods: Two wound swabs were taken from 570 patients, cultured aerobically. The isolates were identified by standard microbiological methods and antibiotic sensitivity pattern was determined.Results: Among 570 patients, 434 (76.14%) were female and 136 (23.85%) were male. Out of the total swabs collected, 548 (96.14%) were culture positive and 36 (6.56%) were having 2 isolates. Pseudomonas aeruginosa (34.93%) was the commonest isolate followed by Staphylococcus aureus (22.77%), Klebsiella pneumoniae (13.87%), Escherichia coli (13.01%) and Coagulase negative staphylococcus (11.31%). Incidence of MRSA was 59.39% and ESBL producers were 61.46 %. Gram positive isolates were 100% sensitive to Vancomycin, Linezolid and Gram negative organisms to Imipenem.Conclusions: Routine periodic sampling of burn wounds would facilitate the selection of appropriate empirical therapy and reduce the incidence of multidrug resistant infections among burn patients

Dengue infection in central India: a 5 years study at a tertiary care hospital

Background: Dengue is one of the most important mosquito borne viral disease with wide spectrum of clinical presentation and often with unpredictable clinical evolution and outcome. Approximately 50 million infections occur annually world-wide, but what’s the real size of the problem in India?  Nobody truly knows...!!  Present study was carried out to determine seropositivity, clinical profile and seasonal variation of dengue infection in central India.Methods: Study was carried out from January 2012 to December 2016. Blood samples were collected from 15,606 patients with dengue like clinical illness and serum was separated. All the samples were subjected to IgM antibody detection by dengue MAC ELISA.Results: Prevalence of dengue in dengue suspected cases was found to be 24.49% (3,822/15,606). Maximum number of positive cases, 1,548 (40.50%) were in the age group of 0-10 years. Males (60.83%) were affected more than females (39.17%). Peak was observed in the months of August, September, October and November. Common presenting features were fever followed by myalgia, arthralgia, headache and bleeding manifestations. Significant drop in platelet count was observed in patients with dengue shock syndrome and dengue haemorrhagic fever.Conclusions: Number of dengue cases in central India are on increase and continued surveillance is essential to determine epidemiological and seasonal trend

Microbiological profile of patients attending sexually transmitted infection/reproductive tract infection clinic in a tertiary care hospital

Background: Sexually transmitted infections (STIs)/reproductive tract infections (RTIs) are an important public health problem worldwide. Growing spread of RTIs/STIs are an augmenting factor for HIV transmission. Due to lack of adequate laboratory infrastructure, there is limited data. Hence information regarding STIs lies essentially on syndromic basis.Methods: This was an observational, cross-sectional study carried from June 2016 to September 2016 with sample size of 300 patients attending STI/RTI clinic. Various samples were collected like scrapings, exudates and swabs from ulcerative lesions for microscopy. Urethral, vaginal and cervical swabs for wet mount, gram stain and culture. Blood sample were collected for RPR, TPHA, ELISA HSV II, HIV, HBsAg. Processing and identification of organism as per NACO guidelines.Results: Out of total 300 cases, 255 (85%) are females and 45 (15%) are males. Maximum cases are from 25-44 years age group. Genital discharge syndrome is more common in females while genital ulcerative syndrome more in males. Coinfection with HIV is found in 17% cases. Herpes genitals (20%) is the most common causative agent for ulcerative STIs in males. VDS is the most common syndrome in Females. Candida (27.8%), G. vaginalis (12.2%) and T. vaginalis (3.5%).Conclusions: Viral and fungal STIs are more common than bacterial STIs. Targeted intervention and contact tracing as done for HIV should be effectively emphasised for STI/RTI also. Syndromic approach should be supplemented by Laboratory diagnosis for more effective outcome

NS1 ANTIGEN DETECTION BY ELISA IN EARLY LABORATORY DIAGNOSIS OF DENGUE INFECTION

Introduction: Dengue is a major public health problem in tropical and sub-tropical regions of the world and it is known for serious life threatening complications. Detection of IgM antibodies forms the mainstay for diagnosis of dengue infection. However, IgM antibodies develop after 4-5 days of infection and there is an urgent need for an alternative diagnostic tools that can detect dengue infection earlier. Aim and Objectives: To evaluate the efficacy of NS1 antigen ELISA for early diagnosis of dengue virus infection in a tertiary care hospital Methods- A total of 2106 serum samples from patients with suspected dengue infection were tested for dengue NS1 antigen and IgM antibody detection by ELISA. Results: 765 (36.32%) were positive for dengue NS1 antigen and 857 (40.69%) were positive for dengue IgM antibody. NS1 antigen was detectable in patient sera from day 1 onwards however; dengue IgM antibody was detected from day 3 onwards. Out of 765 NS1 antigen positive samples, 562 (73.46%) were positive in acute phase of illness and 203 (26.54%) were positive in convalescent phase of illness. Out of 857 MAC ELISA positive samples, 312 (36.41%) were from acute phase of illness and 545 (63.59%) were from early convalescent phase of illness. Combination of two tests resulted in increase in the positivity rate to 52.66% as against to independent positivity rate of 36.32% of NS1 ELISA and 40.69% of MAC ELISA. Conclusion: Combined use of NS1 antigen assay with MAC ELISA test could significantly improve diagnostic sensitivity of dengue infectio

NS1 ANTIGEN DETECTION BY ELISA IN EARLY LABORATORY DIAGNOSIS OF DENGUE INFECTION

Introduction: Dengue is a major public health problem in tropical and sub-tropical regions of the world and it is known for serious life threatening complications. Detection of IgM antibodies forms the mainstay for diagnosis of dengue infection. However, IgM antibodies develop after 4-5 days of infection and there is an urgent need for an alternative diagnostic tools that can detect dengue infection earlier. Aim and Objectives: To evaluate the efficacy of NS1 antigen ELISA for early diagnosis of dengue virus infection in a tertiary care hospital Methods- A total of 2106 serum samples from patients with suspected dengue infection were tested for dengue NS1 antigen and IgM antibody detection by ELISA. Results: 765 (36.32%) were positive for dengue NS1 antigen and 857 (40.69%) were positive for dengue IgM antibody. NS1 antigen was detectable in patient sera from day 1 onwards however; dengue IgM antibody was detected from day 3 onwards. Out of 765 NS1 antigen positive samples, 562 (73.46%) were positive in acute phase of illness and 203 (26.54%) were positive in convalescent phase of illness. Out of 857 MAC ELISA positive samples, 312 (36.41%) were from acute phase of illness and 545 (63.59%) were from early convalescent phase of illness. Combination of two tests resulted in increase in the positivity rate to 52.66% as against to independent positivity rate of 36.32% of NS1 ELISA and 40.69% of MAC ELISA. Conclusion: Combined use of NS1 antigen assay with MAC ELISA test could significantly improve diagnostic sensitivity of dengue infectio

Is fumigation enough for air conditioning units in operation theatres and Intensive care units?

Background:Strict asepsis is necessary in operating theatres (OT) and intensive care units (ICU) as the patients undergo invasive procedures. The filters of contaminated air conditioning (AC) units provide a niche for proliferation of fungi and production of fungal spores.Methods: The routine procedure for maintenance of sterile atmosphere in our hospital, i.e. fumigation and mopping walls with disinfectants often fail to address these fungal spores of the AC filters. We therefore carried out a surveillance of the ACs in ICUs and OTs to find the level of contamination with fungal spores and also to improvise on intervention strategies to tackle the problem. Over 3 months period, 34 ACs from 7 OTs and 2 ICUs were screened by taking 2 swabs from each AC which were then tested for the presence of fungal spores as per standard methods.Results: The contamination rate was 88.2% before fumigation and 76.9% after fumigation. The fungal spore contamination rate was reduced to 20% (1 out of 5 ACs) after servicing of the ACs was done. Aspergillus spp. was the most common fungal isolate.Conclusion: Based on the observations, we recommend regular servicing of the ACs as well as wet mopping of the ducts with sporicidal solution at regular intervals.

Assessing the role of saliva and gargle lavage as a cost-effective alternative to the throat and nasal swabs for diagnosing Covid-19

Background: Presently, the most reliable and common method for definitive diagnosis of COVID-19 is the use of nasal swabs and throat swabs (NTS) by RT-PCR (reverse transcription-polymerase chain reaction). Limited use and efficacy of other sampling methods like gargle lavage have been seen clinically owing to the non-availability of gargle liquid. Aims: The present study was conducted to assess and evaluate the SARS-CoV-2 RNA stability at 4o C in the normal saline as a transport medium and gargle liquid. The present study also assessed the agreement of saliva/gargle liquid and nasal swabs and throat swabs in detecting SARS-CoV-2. Methods: In 30 subjects who had confirmed positive real-time RT-PCR (RT-PCR) positive diagnosis for COVID-19, paired samples of saliva, gargles, and NTS were acquired. For detection of SARS-CoV-2 RNA stability in the normal saline, the collected gargle lavage samples were divided into two aliquots where one sample was processed after 24-30 hours after storing at 4o C, whereas, another sample was processed with routine saliva and NTS sample within 4-6 hours. The agreement was assessed between cycle threshold (Ct) values for the two aliquots using statistical analysis. Results: Negative saliva samples were seen in 6.66% (n=2) subjects with positive NTS and 13.33% (n=4) subjects with negative NTS. A positive saliva sample was seen in 73.33% (n=22) subjects with positive NTS and 6.66% (n=2) subjects with negative NTS. Concerning the comparison of gargle lavage samples processed after 24-30 hours, there was a 3.33% (n=1) negative sample for NTS positive and 16.66% (n=5) for NTS negative. There were 80% (n=24) gargle lavage positive samples for NTS positive and no positive sample for NTS negative. There was total 83.33% (n=25) gargle lavage positive samples and 16.66% (n=5) gargle lavage samples negative samples. For gargle lavage samples processed immediately, there were 3.33% (n=1) negative samples that were positive for NTS and 13.33% (n=4) samples that were positive for NTS. Conclusions: The present study concludes that SARS-CoV-2 RNA remains stable in the gargle samples stored in the normal saline for nearly 24-30 hours. Saliva and gargle lavage serves as acceptable and cost-effective sampling methods for detecting SARS-CoV-2 RNA using RT-PCR. These methods are also acceptable, inexpensive, and simplified methods of collecting samples reducing expenses and workload on the healthcare professionals concerning the sample collection

Farnesol Sensitivity of Serum Induced Yeast to Hyphae Morphogenesis: A Study on Fifty Clinical Isolates of Candida albicans

Aim: Objective of this study was to examine farnesol sensitivity of yeast to hyphae dimorphism in clinical isolates of Candida albicans. Study Design: Variations in virulence attributes contribute to variations in pathogenicity of C. albicans. Ability to switch from yeast to hyphae morphology is an important virulence factor. Farnesol, a quorum sensing molecule is known to play an important role in the regulation of C. albicans morphogenesis. Analysis of farnesol susceptibility of yeast to hyphae conversion may reveal a factor responsible for variation in pathogenicity among clinical isolates of C. albicans. Place and Duration of Study: SCG Medical College & SGGS Memorial Hospital, and School of Life Sciences, SRTM University, Nanded, India. Duration of this study was, December 2008 to December 2010. Methodology: Fifty clinical isolates of C. albicans were recovered from body fluids (such as, sputum, blood, urine, vaginal swab, tracheal swab, throat swab, feces, pus and cerebrospinal fluid, etc.) of patients with different clinical manifestations, in the tertiary care center hospital. Presumptive identification of C. albicans was done on HiCHROM agar- Candida, while confirmation was done by Germ tube formation assay, Carbohydrate assimilation and Corn meal agar test. Serum induced yeast to hyphae morphogenesis in C. albicans was performed in 96 well plates. Recent methodology of micro broth dilution was used for farnesol susceptibility testing in fifty clinical isolates. Results: Farnesol prevented hyphae formation in a concentration dependent manner, in the range 25 to 400 μM. Inhibition of ≥ 50% hyphae was considered as significant reduction in morphogenesis. MIC70 for farnesol mediated inhibition of morphogenesis in C. albicans was at 200 μM. Mean values for percentage inhibition of morphogenesis in fifty strains was compared by analysis of variance (ANOVA). P = 0.05 was considered significant. Conclusion: Susceptibility of yeast to hyphae morphogenesis to the quorum sensing molecule farnesol, varied significantly among clinical isolates of C. albicans. We hypothesize that variation in farnesol sensitivity may be a factor responsible for variable dissemination and infection ability of C. albicans