Trends of Scrub Typhus at A Tertiary Care Hospital In Jaipur, Rajasthan

Introduction: Rickettsia diseases are now established as re-emerging zoonotic bacterial infections in the Indian subcontinent. Objectives: The retrospective study was conducted to see the trends of scrub typhus with cofactors like disease & sex ratio significance and impact of seasons on the disease outcome in the Jaipur, Rajasthan. Methods: A total of 2233 samples were processed between January 2013 to November 2016 suspecting rickettsia infection with complaints of fever, rash, oedema, hepatosplenomegaly, lymphadenopathy and an eschar, with or without a history of tick exposure at Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan. IgM antibodies to Orientia tsutsugamushi antigen were tested by ELISA method. Results: A total of 2233 samples were processed from january 2013 to november 2016. Out of 2233 samples 475 samples were IgM antibody reactive by ELISA method. In 2013 positivity is 36.38% while in 2014 positivity is 24.34%. In 2015, 21.49% positivity rate while jan-nov16, 12.43% positvity. Females are more prone to infection then male patients specially with rural background. Maximum numbers of cases were reported from the month of August to October. Conclusions: Scrub typhus is prevalent but an underdiagnosed disease in India. The prevalence is gradually decreasing with increasing sample size every year with female patients predominence. Trends are more in late rainy season between August and October months. Rickettsia – specific IgM ab ELISA tests can help in early diagnosis & early empiric therapy which can be given to reduce serious complications and mortality. [Manisha JNJIRM 2017; 8(2):9-11

Detection and Prevalence of Inducible Clindamycin Resistance in Clinical Isolates of Staphylococcus aureus: Experience from Tertiary Care Hospital in Jaipur

Background: Staphylococcus aureus is a frequent cause of bacterial infections in both developed and developing countries. Emerging resistance to methicillin in this organism has left us with very few therapeutic alternatives to treat the infections caused by them. Objective: We aimed to determine the prevalence of inducible clindamycin resistance in clinical isolates of S. aureus and antimicrobial susceptibility pattern of S. aureus isolates due to the increasing prevalence of resistance to most antimicrobial agents in staphylococci signifies the need for new effective agents to treat staphylococcal infections. Methods: The study was carried out in the Department of Microbiology at Mahatma Gandhi Hospital, Sitapura, Jaipur, Rajasthan. All S. aureus isolates (non-repetitive) from different clinical samples received in clinical microbiology laboratory from in and outpatients in Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, were included in the study. Results: Out of 157 erythromycin-resistant S. aureus, 74 (47.133%) show MS phenotype, 48 (30.57%) show inducible clindamycin resistance, and 35 (22.29%) show constitutive resistance. All 48 S. aureus isolates which showed inducible clindamycin resistances (D-test positive) were further subjected to antimicrobial susceptibility testing.In the present study, 100% sensitivity was observed by vancomycin, linezolid and tigecycline, followed by tetracycline, 89.58% and gentamicin, 83.33% while 100% resistivity were observed by levofloxacin. Conclusion: We can conclude that there is high percentage of inducible clindamycin resistance among Staphylococcus isolates. If D-test would not have been performed, many inducible clindamycin-resistant S. aureus could have been easily misidentified as clindamycin susceptible, leading to therapeutic failure. Thus, simple and reliable D-test can be incorporated into routine in clinical microbiology laboratory