A Retrospective Audit of Widal Testing For Enteric Fever in the City Of Ahmedabad

Introduction: Widal test has been used extensively for the sero-diagnosis of Enteric fever in India, however, its accuracy and reliability are debatable. We studied widal testing and widal positivity rates in the entire city of Ahmedabad for the diagnosis of Enteric Fever. Methods We screened all 1700 possible diagnostic laboratory facilities, in Ahmedabad, in the public and private sector. We performed telephonic surveys for the initial filtering of facilities that could be conducting widal testing. It was followed by physical visits to probable facilities to confirm testing methods and preservation of reports of widal testing. We followed a systematic process for screening and selection of 23 laboratories, which conducted widal tests and had reliable data. While 14 laboratories refused to share data, data provided by three of them were inappropriate and couldn’t be used.  We finally analyzed data from four large public hospitals, one private trust hospital and one corporate laboratory for variable periods in a span of 15 years (2000 – 2015). Result: The Widal testing rate was found to be 8.7% and widal positivity as 12.5% in a sample of 1.2 million clinically suspected in-patients. In 15 years, the private hospital had admitted 1/10th as many cases as all the public hospitals together. However, the widal testing and positivity rates were similar in both. We observed a lower proportion of widal positivity among children below 12 years and a disproportionate, but insignificant, gender distribution of widal positivity. Conclusion: This study indicates that the widal test, which is meant to be an initial screening test, is widely used in the city. We propose linkage of testing and reporting of widal with other more reliable and accurate tests such as Typhidot and blood culture in order to strengthen our knowledge of enteric fever epidemiology in India

Epidemiological and microbiological profile of infective keratitis in Ahmedabad

Context : Study of patients attending tertiary care ophthalmology institute at Ahmedabad. Aims : To study the microbiological etiology and epidemiological factors associated with suppurative keratitis. Settings and Design : A total of 150 corneal scrapings were evaluated from patients presenting with corneal ulcers at a tertiary ophthalmology center, Ahmedabad from July 2007 to June 2008. Materials and Methods : Scrapings were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. Socio-demographic data and risk factors were recorded. Results : Ninety percent (135/150) people with corneal ulcers had trauma as predisposing factor for keratitis. Trauma due to wooden objects was the leading cause (46/135) followed by vegetable matter and stone injury (23/135). Microbial etiology was established in 59.3% (89/150) of scrapings. Out of 89 positive isolates, 65.1% (58/89) were bacterial while 34.9% (31/89) were fungal. Among the bacterial isolates, 60.3% (35/58) were Gram-positive cocci while 39.7% (23/58) were Gram-negative bacilli. The most common bacterial isolate was Staphylococus aureus (32.7%, 19/58) followed by coagulase-negative Staphylococci (25.8%, 15/58) and Pseudomonas (18.9%, 11/58). Among the 31 fungal pathogens, Aspergillus species was the most common (35.4%11/31), followed by Fusarium species (22.5%, 7/31). Conclusion : Trauma with wooden material is the most common predisposing factor for suppurative keratitis. Males were more affected than females. Bacterial ulcers were more common than fungal in areas in and around Ahmedabad. Staphylococcus aureus and Aspergillus were the commonest bacterial and fungal isolates respectively. Geographical variation persists in microbial etiology of suppurative keratitis