Vaccines: Propaganda and Practice

Vaccines are a cost effective, time tested means of reducing morbidity and mortality. As more and more new vaccines are introduced and more diseases come under the purview of ‘vaccination net’, the routine immunization program is sidelined.\ud This is compounded by vaccination practices in private health care system and anti vaccine propaganda and confusing pro vaccine propaganda. The primary purpose of the vaccine is shifting from prevention of diseases to monetary gains for the health care providers and manufacturers. There is a need to regulate the vaccination practices in the private health care system especially in the developing countries. The regulatory process should educate not only the community but also the health care providers and take adequate measures to control the ‘vaccine market forces

UTILITY OF ANTIGEN DETECTION TEST AND POLYMERASE CHAIN REACTION IN THE DIFFERENTIATION OF TUBERCULOUS AND NON-TUBERCULOUS MYCOBACTERIA

Objectives: Cultivation and identification of mycobacteria to species level remains difficult and time-consuming. Hence, easy and rapid diagnostic methods are necessary for the differentiation of Mycobacterium tuberculosis (MTB) from non-tuberculous mycobacteria (NTM). The present study aims to detect and differentiate MTB from NTM isolated from clinical samples by immunochromatographic test (ICT) and polymerase chain reaction (PCR). Methods: Over a period of 1 year, clinical samples (n=496) received from suspected cases of TB, at the Department of Microbiology, Kasturba Medical College Hospital, Mangalore were cultured to isolate Mycobacterium spp. Identification of all the isolates was done by conventional biochemical technique, ICT, and PCR. Results: Among the 496 samples processed, 49 (9.87%) were acid-fast bacilli smear positive and 59 (11.89%) samples showed the growth of Mycobacterium spp. Among these, 10 were rapid growers, 49 were slow-growing mycobacteria, out of which 30 were MTB as identified by conventional biochemical reaction. Out of 59 Mycobacterial isolates subjected to ICT for the detection of MPT 64 antigen, only 28 were identified as MTB. However, all the 30 isolates were correctly identified as MTB by PCR. Conclusion: Hence, PCR is essential for rapid differentiation of non-tuberculous Mycobacterium from MTB. False negative results seen with immunochromatographic MPT 64 antigen assay could be due to mutations within the mpt64 gene. Further studies are necessary to characterize these PCR-positive and immunochromatographic assay negative MTB isolates

A RISING THREAT – RISK FACTORS AND OUTCOMES RELATED TO INFECTIONS WITH ACINETOBACTER SPECIES

ABSTRACTObjective: Acinetobacter species is an important cause of community as well as nosocomial infections with a high mortality rate. The study was doneto analyze the risk factors associated with Acinetobacter infections and their outcomes.Methods: The clinical details of 100 patients having infections with Acinetobacter species over a period of 1-year were analyzed for underlying riskfactors and outcomes. The antibiotic sensitivity results were interpreted according to the Clinical Laboratory Standards Institute guidelines.Results: Majority of the infections caused by the Acinetobacter species were lower respiratory tract infections, most common being ventilatorassociatedpneumonia. 47% of the isolates were multi drug resistant and 26% were extensively drug resistant. There is a significant chance of drugresistance and a poor outcome with intensive care unit (ICU) stay, prolonged hospital stay of more than 7 days, the presence of 5 or more risk factors.Endotracheal intubation and mechanical ventilation were the risk factors for increased drug resistance in the ICU. Drug resistance was also seen morefrequently in patients with chronic obstructive pulmonary disease, chronic kidney disease, and patients on post-operative care.Conclusion: The steady increase in drug resistant Acinetobacter species and limited antibiotics available advocates an uncompromising approachtoward infection control and a judicious use of antibiotics especially in the ICU. An understanding about the risk factors helps in the appropriateapproach and management of the patient.Keywords: Acinetobacter, Risk factors, Invasive procedures, Nosocomial

Healthcare-Associated Methicillin-Resistant Staphylococcus aureus : Clinical characteristics and antibiotic resistance profile with emphasis on macrolide-lincosamide...

Objectives: Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen worldwide and its multidrug resistance is a major concern. This study aimed to determine the clinical characteristics and antibiotic susceptibility profile of healthcare-associated MRSA with emphasis on resistance to macrolide-lincosamide-streptogramin B (MLSB) phenotypes and vancomycin. Methods: This cross-sectional study was carried out between February 2014 and February 2015 across four tertiary care hospitals in Mangalore, South India. Healthcare-associated infections among 291 inpatients at these hospitals were identified according to the Centers for Disease Control and Prevention guidelines. Clinical specimens were collected based on infection type. S. aureus and MRSA isolates were identified and antibiotic susceptibility tests performed using the Kirby-Bauer disk diffusion method. The minimum inhibitory concentration of vancomycin was determined using the Agar dilution method and inducible clindamycin resistance was detected with a double-disk diffusion test (D-test). Results: Out of 291 healthcare-associated S. aureus cases, 88 were MRSA (30.2%). Of these, 54.6% were skin and soft tissue infections. All of the isolates were susceptible to teicoplanin and linezolid. Four MRSA isolates exhibited intermediate resistance to vancomycin (4.6%). Of the MRSA strains, 10 (11.4%) were constitutive MLSB phenotypes, 31 (35.2%) were inducible MLSBphenotypes and 14 (15.9%) were macrolide-streptogramin B phenotypes. Conclusion: Healthcare-associated MRSA multidrug resistance was alarmingly high. In routine antibiotic susceptibility testing, a D-test should always be performed if an isolate is resistant to erythromycin but susceptible to clindamycin. Determination of the minimum inhibitory concentration of vancomycin is necessary when treating patients with MRSA infections

Drug Resistance in Salmonella typhi: Tip of the Iceberg

Salmonella typhi is one of the most resistant organisms with multi-drug resistant strains reported from many countries. Initially, individual plasmids were known to code for resistance,but since 1988 a single plasmid has been identified to code for multidrug resistance. It has been found that in certain areas, S. typhi has lost this acquired resistance

Laboratory Diagnosis, Safety and Testing Strategies of Novel SARS COV 2

The COVID 19 Pandemic is the most defining health care crisis of the present times. It has challenged the health care facilities, overwhelmed the health care personnel and baffled the scientists and researchers. There is no quick fix in a pandemic of this proportion. The past four months has seen many new aspects of this disease, and newer evolving strategies to rein in the pandemic. This commentary seeks to deal with the various aspects of laboratory diagnosis, safety and testing strategies adopted by different countries

Comparison of Various Culture Methods for Isolation of Group B Streptococcus from Intrapartum Vaginal Colonization

Aims: Group B Streptococcus (GBS) is one of the most common causes of neonatal sepsis throughout the world. Reports of vaginal colonization of GBS in India are few and variable. A study was conducted on pregnant women in a tertiary care hospital to compare various methods for isolation of GBS, to study the prevalence of GBS in pregnant women in third trimester, and to determine risk factors for GBS colonization. Settings and Design: Observational descriptive study. Materials and Methods: High vaginal swabs from 150 pregnant women in their third trimester were used to compare three methods for isolation of GBS viz. direct culture on 5% Sheep Blood agar, direct culture on selective Columbia Blood Agar and culture in LIM enrichment broth with subsequent culture on 5% Sheep Blood agar. A history of associated risk factors was also taken. Statistical Analysis Used: Statistical analysis was performed by Chi–square test. Results: Isolation was best from LIM enrichment broth with subsequent culture on 5% Sheep Blood Agar. Prevalence of GBS colonization by using culture method was 12.67%. Most frequently associated risk factor was intrapartum fever (42.11%). Conclusions: Standard Culture Method using LIM enrichment should be adopted as standard practice for isolation of GBS from vaginal swabs