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  ~ Table of Contents - Current issue
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January-March 2015
Volume 33 | Issue 1
Page Nos. 1-197

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EDITORIAL  

Need to rationalize linezolid use Highly accessed article p. 1
A Kapil
DOI:10.4103/0255-0857.148368  PMID:25559994
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REVIEW ARTICLE Top

Dengue vaccines: Challenges, development, current status and prospects Highly accessed article p. 3
A Ghosh, L Dar
PMID:25559995
Infection with dengue virus (DENV) is the most rapidly spreading mosquito-borne viral disease in the world. The clinical spectrum of dengue, caused by any of the four serotypes of DENV, ranges from mild self-limiting dengue fever to severe dengue, in the form dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Increased rates of hospitalization due to severe dengue, during outbreaks, result in massive economic losses and strained health services. In the absence of specific antiviral therapy, control of transmission of DENV by vector management is the sole method available for decreasing dengue-associated morbidity. Since vector control strategies alone have not been able to satisfactorily achieve reduction in viral transmission, the implementation of a safe, efficacious and cost-effective dengue vaccine as a supplementary measure is a high public health priority. However, the unique and complex immunopathology of dengue has complicated vaccine development. Dengue vaccines have also been challenged by critical issues like lack of animal models for the disease and absence of suitable markers of protective immunity. Although no licensed dengue vaccine is yet available, several vaccine candidates are under phases of development, including live attenuated virus vaccines, live chimeric virus vaccines, inactivated virus vaccines, subunit vaccines, DNA vaccines and viral-vectored vaccines. Although some vaccine candidates have progressed from animal trials to phase II and III in humans, a number of issues regarding implementation of dengue vaccine in countries like India still need to be addressed. Despite the current limitations, collaborative effects of regulatory bodies like World Health Organization with vaccine manufacturers and policy makers, to facilitate vaccine development and standardize field trials can make a safe and efficacious dengue vaccine a reality in near future.
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ORIGINAL ARTICLES Top

Tumour necrosis factor-alpha promoter polymorphism and its association with viral dilated cardiomyopathy in Indian population: A pilot study p. 16
B Mishra, M Sharma, S Sarkar, A Bahl, UN Saikia, RK Ratho
DOI:10.4103/0255-0857.148370  PMID:25559996
Purpose: Tumour necrosis factor-α (TNF-α), a pro-inflammatory cytokine has been implicated in the pathophysiology of several viral infections. TNF-α promoter gene polymorphism is thus believed to play the modulating role in this disease pathogenesis. Several studies have shown the increased level of TNF-α in dilated cardiomyopathy (DCM). However, the role of the TNF-α promoter polymorphism is yet to be delineated in this regard. The present study for the first time tried to explore the association of TNF-α gene polymorphism with DCM of viral aetiology. Materials and Methods: Eighteen histopathologically proven DCM cases with viral genome positivity and 17 healthy controls were genotyped using polymerase chain reaction of TNF-α promoter gene followed by restriction fragment length polymorphism to determine the SNPs of -238G/A, -308G/A, -857C/T and -863C/A. Results: Of the 18 DCM cases 4 (22.2%) were positive for adenovirus (AdV), 2 (11.1%) for enterovirus (EV) and 12 (66.7%) had co-infection. Six of the 18 DCM cases (35.3%) had -238G/A polymorphism, and 10 (55.5%) had -863 homozygous AA genotype. The association of these polymorphisms was statistically significant as compared to controls (P < 0.05). Conclusions: The present pilot study suggests the possible association of TNFα -238G/A and -863C/A polymorphism with DCM of viral aetiology.
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Detection of the classical G2576U mutation in linezolid resistant Staphylococcus aureus along with isolation of linezolid resistant Enterococcus faecium from a patient on short-term linezolid therapy: First report from India p. 21
S Rai, DK Niranjan, T Kaur, NP Singh, V Hada, IR Kaur
DOI:10.4103/0255-0857.148371  PMID:25559997
Purpose: Linezolid is an effective drug against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). We describe the emergence of linezolid resistance in MRSA and VRE from India. Material and Methods: One MRSA and two VRE strains were isolated from a patient on linezolid therapy of one week duration. All three isolates were resistant to linezolid with minimal inhibitory concentrations (MIC) ≥4 mg/L. The 746-bp region flanking the possible G2576U mutation on the corresponding DNA from the 23S rRNA was amplified by polymerase chain reaction (PCR) and amplicons were sequenced for all the three isolates. Conjugation experiments using the linezolid resistant MRSA (LRMRSA) and linezolid resistant VRE (LRVRE) isolates as donors and wild strains of corresponding genera as recipients were performed. Results: The MRSA isolate had the classical G2576U mutation. High quality value scores in the sequencing software validated the mutation. Conjugation studies did not indicate presence of transferable resistance for linezolid. Sequencing did not indicate presence of any mutation in the two LRVRE isolates. Conclusions: This is the first report from India citing resistance in Staphylococcus and Enterococcus against Linezolid.
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Changing paradigm of Cryptococcal meningitis: An eight-year experience from a tertiary hospital in South India p. 25
KPP Abhilash, S Mitra, JJJ Arul, PM Raj, V Balaji, R Kannangai, SA Thomas, OC Abraham
DOI:10.4103/0255-0857.148372  PMID:25559998
Background: Cryptococcal meningitis (CM) is a common opportunistic fungal infection causing sub-acute meningitis with the potential for complications and significant mortality. We conducted this study to describe the difference in presentation and outcome between HIV-infected and HIV-uninfected patients. Materials and Methods: Patients admitted to a tertiary care centre between 2005 and 2013 with confirmed CM were included in the analysis. Details of the clinical presentation, laboratory findings, treatment details, risk factors for infection and outcome were documented and analysed. Results: During the study period, 102 (87.2%) cases of CM occurred among HIV infected individuals, whereas 15 (12.8%) occurred among HIV-uninfected patients. HIV-infected patients with CM were younger compared with HIV-uninfected patients (38.2 ± 8.5 years vs. 45 ± 11.5 years; P = 0.07). The median duration of symptoms prior to presentation was shorter in the HIV-infected group (20 ± 32 vs. 30 ± 42; P = 0.03). There was no difference between the cerebrospinal fluid (CSF) lymphocyte counts, CSF protein counts, and CSF sugar levels in both the groups. The diagnostic yield of Cryptococcus was similar with CSF India ink smear (89% vs. 87%), CSF fungal culture (95% vs. 87%), and blood culture (100% vs. 75%) in both the groups. Case fatality rate in the HIV-infected group was 30.6%, whereas there were no deaths in the HIV-uninfected group. Conclusion: HIV-infected patients with CM have a worse outcome compared to HIV-uninfected patients. The overall trend over 3 decades shows increasingly successful rates of treatment and hence early diagnosis and treatment are of paramount importance.
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Complete sequencing of an IncX3 plasmid carrying blaNDM-5 allele reveals an early stage in the dissemination of the blaNDM gene p. 30
M Krishnaraju, C Kamatchi, AK Jha, N Devasena, R Vennila, G Sumathi, R Vaidyanathan
DOI:10.4103/0255-0857.148373  PMID:25559999
Purpose: The aim of the present study was to perform molecular characterisation of the blaNDM plasmids and to understand the mechanism of its spread among pathogenic bacteria. Materials and Methods: Seventy-six non-repetitive carbapenem-resistant isolates which were collected during Nov 2011 to April 2013 from four hospitals in Chennai were analyzed for the presence of the blaNDM gene by PCR. Further, the genetic context of the blaNDM gene was analyzed by PCR specific to ISAba125 and bleMBL gene. One of the blaNDM plasmid was completely sequenced in the Illumina HiSeq platform. Results: Twenty-three isolates consisting of 8 Escherichia coli, 8 Klebsiella pneumoniae, 3 Klebsiella oxytoca, 3 Acinetobacter baumanii and 1 Pseudomonas aeruginosa were found to carry the blaNDM gene. In 18 isolates the blaNDM gene was associated with a bleMBL gene and the ISAba125 element. The complete sequencing of pNDM-MGR194 revealed an IncX3 replication type plasmid, with a length of 46,253 bp, an average GC content of 47% and 59 putative ORFs. The iteron region contained the blaNDM5 gene and the bleMBL , trpF and dsbC genes downstream and an IS5 inserted within the ISAba125 element upstream. Conclusion: This is the first report where the blaNDM gene insertion in a plasmid is not accompanied by other resistance gene determinants. These observations suggest that the IncX3 plasmid pNDM-MGR194 is an early stage in the dissemination of the blaNDM .
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Rising trend of antimicrobial resistance among Neisseria gonorrhoeae isolates and the emergence of N. gonorrhoeae isolate with decreased susceptibility to ceftriaxone p. 39
T Bharara, P Bhalla, D Rawat, VK Garg, K Sardana, A Chakravarti
DOI:10.4103/0255-0857.148374  PMID:25560000
Context: Gonorrhoea is one of the most common sexually transmitted infections (STI) in developing countries and is a global health problem. Aims: To analyze the trend of antimicrobial susceptibility of Neisseria gonorrhoeae isolates over the years, in a tertiary care hospital of North India. Settings and Design: The study population comprised males with urethritis and females with endocervicitis attending STI clinic of our hospital. Materials and Methods: In our STI laboratory, all gonococcal isolates are subjected to antimicrobial susceptibility testing by disc diffusion method as per CLSI guidelines. β-lactamase production is determined by chromogenic cephalosporin test. Minimum Inhibitory Concentration (MIC) for ceftriaxone is determined by E-test. Statistical Analysis Used: Data were expressed as percentages. The differences in percentages were tested for statistical significance by using χ2 test and P values were determined. Results: The percentage of penicillinase producing N. gonorrhoeae (PPNG) increased from 8% in 1995-96 to 20% in 2004-05 and 88% in 2011-2013. Quinolone-resistant N. gonorrhoeae (QRNG) showed a significant increase from 12% in 1995-96 to 98.3% in 2004-05, while 84% isolates were found to be QRNG by 2011-2013. In January 2013 we detected our first gonococcal isolate with decreased susceptibility to third-generation cephalosporins; Ceftriaxone, Cefixime and Cefpodoxime (MIC for ceftriaxone = 0.19 μg/ml). Conclusions: The results of our study highlighted an alarming increase in the percentage of PPNG and QRNG strains over the years. Emergence of N. gonorrhoeae isolates with decreased susceptibility to third-generation cephalosporins is a cause of concern and thus emphasises the importance of antimicrobial susceptibility testing.
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Surveillance of Acute Respiratory Infections in Mumbai during 2011-12 p. 43
RD Chavan, ST Kothari, K Zunjarrao, AS Chowdhary
DOI:10.4103/0255-0857.148376  PMID:25560001
Purpose: Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality in individuals aged less than 5 years. ARI often leads to hospitalisation, and it has been indicated that causative viral and bacterial infections go undetermined and results in the occurrence of resistant strains. The objective of the study was to assess the prevalence of various viral and bacterial infections in patients with ARIs. Materials and Methods: Two hundred samples were collected from July 2011 to July 2012 with patients suffering from ARI. Viral and bacterial infections were determined by real time reverse transcriptase polymerase chain reaction. Results: Influenza-like illness (ILI) consisted of 109 patients and ARI consisted of 91 patients. Pandemic influenza A H1N1 was the major viral infection with 21 (19.2%) patients in ILI as compared with 16 (17.4%) patients in ARI. Respiratory syncytial virus (RSV) was found to be 1 (0.9%) in ILI and ARI. Viral co-infections were 16 (14.4%) in ILI and 4 (4.37%) in ARI where pandemic influenza A H1N1 and influenza type B were major contributors. In bacterial infections, Streptococcus pneumoniae with 11 (10.9%) cases were predominant in both the groups. Bacterial co-infection accounted for only 1 (1.09%) case in both the groups but the most significant finding was the viral-bacterial co-infection in which Haemophilus influenzae was the major co-infecting bacteria with the influenza viruses with 4 (4.36%) cases as compared with Streptotoccus pneumoniae. Conclusion: This data indicate the need to undertake continued surveillance that will help to better define the circulation of respiratory viruses along with the bacterial infections.
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Device-associated infections at a level-1 trauma centre of a developing Nation: Impact of automated surveillance, training and feedbacks p. 51
P Mathur, V Tak, J Gunjiyal, SA Nair, S Lalwani, S Kumar, B Gupta, S Sinha, A Gupta, D Gupta, MC Misra
DOI:10.4103/0255-0857.148378  PMID:25560002
Purpose: Device-associated infections constitute the majority of health care-associated infections (HAIs) in ICUs. Trauma patients are predisposed to acquire such infections due to various trauma-related factors. The prevalence of HAIs is underreported from developing nations due to a lack of systematic surveillance. This study reports the impact of an intensive surveillance on the rates and outcome of device-associated infections in trauma patients from a developing country and compares the rates with a previous pilot observation. Materials and Methods: The study was conducted at a level-1 trauma centre of India. Surveillance for ventilator-associated pneumonia (VAP), central line-associated blood stream infections (CLA-BSIs) and catheter-associated urinary tract infections (CA-UTIs) was done based on centre for disease control-National Healthcare Safety Network (CDC-NHSN) definitions. The impact of an intensive surveillance, education and awareness drive on the rates of infections over the study period, and compliance to preventive bundles and hand hygiene was assessed. Results: A total of 15,462 ventilator days, 12,207 central line days and 17,740 urinary catheter days were recorded in the study population. The overall rates of VAP, CLA-BSI and CA-UTI were respectively 17, 7.2 and 15.5/1000 device days. There was a significant correlation between device days and the propensity to develop infections. Infections were the cause of death in 36.6% of fatal trauma cases. A significantly higher rate of VAP, CLA-BSI and CA-UTIs was noted in fatal cases. The compliance to ventilator bundle, central line bundle, bladder bundle and hand hygiene were 74.5%, 86%, 79.3% and 64.6%, respectively. A high rate of multi-drug-resistance was observed in all pathogens. A gross reduction in the rates of all infections was observed over time during the study due to implementation of a stringent surveillance system, feedbacks and education. The compliance to hand hygiene and preventive bundles also increased over time. Conclusion: The automated surveillance was easy and useful for data entry and analysis. Surveillance had a significant impact on reduction of HAIs and mortality in trauma patients.
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Usefulness of a centrifuged buffy coat smear examination for diagnosis of malaria p. 63
S Mohanty, R Sharma, M Deb
DOI:10.4103/0255-0857.148380  PMID:25560003
Purpose: Malaria continues to be a global public health challenge. Microscopic examination of peripheral blood smear (PBS) is the standard method for malaria diagnosis, which is easily available and has low cost but its reliability is questionable at low level of parasitaemia. The present study was undertaken to assess the usefulness of a modified centrifuged buffy coat smear (CBCS) technique for diagnosis of malaria and to compare it with conventional PBS examination and antigen detection test. Materials and Methods: The study was carried out over a 6-month period from July to December 2011. Blood samples (2-3 ml per patient) collected in EDTAvials from patients with a clinical suspicion of malaria were subjected to all three tests, that is PBS, CBCS and antigen test and results were compared with antigen test as the gold standard. Result: Of 1655 samples received, 394 (23.8%) samples were positive for infection with malaria parasites. All the three tests detected malaria infection equally in 279 samples, and gave varied results in the remaining 115 samples. Addition of centrifugation (i.e. CBCS) to the conventional method of PBS enabled detection of 80 more cases of plasmodia infection, especially (43, 53.7%) at low levels of parasitaemia (<200 parasites/μl). While both PBS and CBCS had excellent specificity (99.7% and 99.2%, respectively), PBS examination had low sensitivity (72.9%) in detecting malaria parasites in comparison to CBCS. The sensitivity of CBCS in detecting malaria parasites was 91.9%. Conclusion: The development of easy, rapid and accurate tests for the reliable detection of plasmodia infection is highly desirable. The CBCS technique fulfils most of these criteria and may be adopted for rapid and reliable diagnosis of malaria in resource-limited settings.
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Seroprevalence of Scrub typhus at a tertiary care hospital in Andhra Pradesh p. 68
A Ramyasree, U Kalawat, ND Rani, A Chaudhury
DOI:10.4103/0255-0857.148381  PMID:25560004
Introduction: Scrub typhus is a rickettsial infection which is caused by Orientia tsutsugamushi and transmitted by the bite of the chigger of a mite. Delay in diagnosis can be fatal otherwise the treatment is simple, doxycycline being the drug of choice. Indirect immunoflurescence is considered gold standard but it is not used in India as it is costly and also not available. There is need for rapid, economic and simple test for the diagnosis of scrub typhus. This study was taken up to study the seroprevalence of scrub typhus in Andhra Pradesh and to compare two commonly used serological methods; rapid test and IgM ELISA. Materials and methods: This is a prospective study in which 100 serum samples from clinically suspected cases collected over a period of 3 months were processed for the detection of IgM antibodies for scrub typhus by ELISA and Rapid test. Samples were also tested for leptospirosis and dengue fever which the other common causes of fever prevalent in this region. Results: Total number of samples processed was 100 of which 52 were males and 48 females. Among the hundred samples 39 were seropositive. Positivity was higher in the age group of patients between 16 and 30 yrs of age. There was 97% correlation between ELISA and rapid method. Of the 100 samples only three samples positive by ELISA were negative by rapid method. Fever was the most common manifestation and there was no eschar and no mortality reported. Conclusion: Scrub typhus should be included in the differential diagnosis of fever of unknown origin along with dengue, malaria and leptospirosis which are the other common endemic infections in this part of the country.
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Comparison of multiplex RT-PCR with virus isolation for detection, typing and sub-typing of influenza virus from influenza-like illness cases p. 73
S Dhakad, PC Mali, S Kaushik, AA Lal, S Broor
DOI:10.4103/0255-0857.148383  PMID:25560005
Purpose: Influenza epidemics and periodic pandemics occur worldwide resulting in significant mortality, morbidity and economic loss. There is need for a sensitive, rapid and cost-effective assay to detect, type and sub-type influenza viruses, as cell culture has a long turnaround time. Materials and Methods: Nasopharyngeal swabs were collected from patients presenting with influenza-like illness (ILI) at AIIMS OPD and Primary Health Centre Ballabhgarh (Haryana). From June 2007 to January 2009 and then from September to November 2009, of 1567 specimens collected, 544 were randomly selected and were tested by virus culture using Madin-Darby Canine Kidney (MDCK) cells and by reverse transcription polymerase chain reaction (RT-PCR) for influenza A using primers for matrix gene and for influenza B using non-structural gene (NS) primers. All influenza A positives were sub-typed using primers for HA and NA genes of A/H1, A/H3. A separate multiplex RT-PCR having primers from matrix and HA genes of pandemic A (H1N1) pdm09 viruses was carried out on samples collected after September 2009. Results: Of the 544 samples, 136 (25%) were positive for influenza by RT-PCR. Further typing analysis revealed 86 (63.2%) were typed as influenza A and 47 (34.5%) as influenza B viruses and 3 (2%) samples showed dual infection with influenza A and B. Of the 86 influenza A positive samples 48 (55.8%) were identified as seasonal influenza A/H1N1, 22 (25.6%) as A (H1N1) pdm09 and 16 (18.6%) as A/H3N2. Comparison of influenza positivity using virus culture revealed that only 97/136 (71.3%) were influenza positive. Sensitivity of viral detection was lowest for seasonal A/H1 (26/48; 54%), followed by H3N2 (11/16; 68.7%) and influenza B (38/47; 80.8%); all influenza A/H1N1pdm09 viruses were detected by both methods. Conclusion: RT-PCR is a sensitive, low cost and rapid screening test for diagnosing influenza infection during epidemics and pandemics. mRT-PCR increased the detection rates for influenza by 28.6% as compared with virus isolation and thus is a useful assay in both diagnostic and epidemiological settings in resource poor countries.
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Current scenario of Opportunistic and co-infections in HIV-infected individuals at a tertiary care hospital in Mumbai, India p. 78
VR Chavan, V Chaudhary, P Ahir, R Mehta, PS Mavani, C Kerkar, JM Pramanik
DOI:10.4103/0255-0857.148386  PMID:25560006
Purpose: An update on opportunistic infections/co-infections (OIs/CIs) is essential to understand the success of highly active antiretroviral therapy offered by the government agencies in reducing AIDS-related OIs/CIs. Hence, the present study aimed to evaluate the frequency of OIs/CIs in HIV-positive individuals at a tertiary care hospital in Mumbai. Its' association with CD4 counts, anti-retroviral treatment and on HIV transmission was also determined. Materials and Methods: An observational study was designed to evaluate different OIs/CIs in individuals, who tested positive for HIV infection at the ICTC/Shakti Clinic of Seth G.S. Medical College and KEM Hospital, Mumbai. Data analysis was done with the use of SPSS software (version 19.0, SPSS, Chicago, IL, USA). P value was considered significant if it is < 0.05. Results: Heterosexual contact was the major route of transmission among the enrolled 185 individuals. Ninety (48.06%) HIV-infected individuals were with OIs/CIs. Tuberculosis (TB) was the most common OI (68.8%). Other CIs noted were Herpes zoster, syphilis, hepatitis C and B, malaria, typhoid and dengue. The median CD4 count in HIV-positive individuals with TB was 337 ± 248 cells/μl, and 67.7% of individuals with OIs/CIs had low CD4 counts (<400 cells/μl). Individuals in 31-40 years of age group had significantly (P = 0.01) more OIs/CIs. More (53.7%) spouse/children of HIV-positive individuals without OIs/CIs were HIV-1 positive. Low proportions of individuals with or without OIs/CIs were on ART. Conclusion: Nearly half of HIV-infected individuals were with OIs/CIs. Initiation of free ART programme since 2004 possibly associated with the type and rate of OIs/CIs. Tuberculosis and multiple OIs/CIs were associated with low CD4 counts. Infection was high in 31-40 years age group. Most of the spouses of individuals without OIs/CIs were HIV positive, indirectly indicates lack of condom use or lack of awareness of condom use.
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Contribution of efflux pumps in fluroquinolone resistance in multi-drug resistant nosocomial isolates of Pseudomanas aeruginosa from a tertiary referral hospital in north east India p. 84
D Choudhury, A Das Talukdar, AP Maurya, M Dutta Choudhury, D Dhar (Chanda), A Chakravarty, A Bhattacharjee
DOI:10.4103/0255-0857.148388  PMID:25560007
Background: Pseudomonas aeruginosa is one of the leading opportunistic pathogen and its ability to acquire resistance against series of antimicrobial agents confine treatment option for nosocomial infections. Increasing resistance to fluroquinolone (FQ) agents has further worsened the scenario. The major mechanism of resistance to FQs includes mutation in FQs target genes in bacteria (DNA gyrase and/or topoisomerases) and overexpression of antibiotic efflux pumps. Objective: We have investigated the role of efflux pump mediated FQ resistance in nosocomial isolates of P. aeruginosa from a tertiary referral hospital in north eastern part of India. Materials and Methods: A total of 234 non-duplicate, consecutive clinical isolates of P. aeruginosa were obtained from a tertiary referral hospital of north-east India. An efflux pump inhibitor (EPI), carbonyl cyanide m-chlorophenylhydrazone (CCCP) based method was used for determination of efflux pump activity and multiplex polymerase chain reaction (PCR) was performed for molecular characterisation of efflux pump. Minimum inhibitory concentration (MIC) reduction assay was also performed for all the isolates. Results and Conclusion: A total number of 56 (23%) have shown efflux mediated FQ resistance. MexAB-OprM efflux system was predominant type. This is the first report of efflux pump mediated FQ resistance from this part of the world and the continued emergence of these mutants with such high MIC range from this part of the world demands serious awareness, diagnostic intervention, and proper therapeutic option.
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Clonal evolution multi-drug resistant Acinetobacter baumannii by pulsed-field gel electrophoresis p. 87
P Mohajeri, A Farahani, MM Feizabadi, B Norozi
DOI:10.4103/0255-0857.148390  PMID:25560008
Background: Acinetobacter baumannii is usually multi-drug resistant (MDR), including third generation cephalosporins, amino glycosides and fluoroquinolone. Resistance to these antibiotics is mediated by multiple factors such as: lactamases, efflux pumps and other mechanisms of resistance. Pulsed-field gel electrophoresis (PFGE) was then used to investigate the genetic relationships among the MDR isolates. Aim: The aim of this study was to determine MDR isolates and the existence of OXAs genes among MDR isolates of A. baumannii collected from Kermanshah hospitals in west of Iran. Materials and Methods: Forty-two MDR A. baumannii were collected from patients at Kermanshah hospitals. The isolates were identified by biochemical tests and API 20NE kit. The susceptibility to different antibiotics by disk diffusion method was determined. Polymerase chain reaction (PCR) was performed for detection of blaOXA-23-like , blaOXA-24-like , blaOXA-51-like and blaOXA-58-like betalactamase genes in isolates and clonal relatedness was done by PFGE (with the restriction enzyme ApaI) and patterns analyzed by Bionumeric software. Results: This study showed high resistant to ciprofloxacin, piperacillin, ceftazidime and also resistant to other anti-microbial agents and more spread blaOXA-23-like gene (93%) in MDR isolate. The PFGE method obtained six clones: A (10), B (9), C (5), D (4), E (11) and F (3) that clone E was outbreak and dominant in different wards of hospitals studied. Conclusion: An isolate from the emergency ward of these hospitals had indistinguishable isolates PFGE profile and similar resistance profile to isolates from intensive care unit (ICU), suggesting likely transmission from ICU to emergency via patient or hospital staff contact.
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Detection of phospholipase activity of Candida albicans and non albicans isolated from women of reproductive age with vulvovaginal candidiasis in rural area p. 92
SR Fule, D Das, RP Fule
DOI:10.4103/0255-0857.148392  PMID:25560009
Background: Vulvovaginal candidiasis (VVC) is most common accounting for 17 to 39% of symptomatic women. Both Candida albicans and non albicans Candida species are involved in VVC. Amongst various virulence factors proposed for Candida, extracellular phospholipases is one of the virulence factor implicated in its pathogenicity. With this background the present study was carried out to find the prevalence of different Candida species and to detect phospholipase producing strains isolated from symptomatic women with VVC. Materials and Methods: At least two vaginal swabs from 156 women of reproductive age with abnormal vaginal discharge were collected. Direct microscopy and Gram's stained smear examined for presence of budding yeast and pseudo mycelia followed by isolation and identification of Candida species. Extracellular phospholipase activity was studied by inoculating all isolates on Sabouraud's dextrose egg yolk agar (SDA) medium. Results: Of the 156 women with curdy white discharge alone or in combination with other signs, 59 (37.82%) women showed laboratory evidence of VVC. A total of 31 (52.54%) women had curdy white discharge followed by 12 (20.33%) with other signs and symptoms. C. albicans (62.59%) and non albicans Candida (37.28%) in a ratio of 1.68:1 were isolated. Of the 37 strains of C. albians 30 (81.08%) showed the enzyme activity. Seventeen (56.66%) strains showed higher Pz value of < 0.70 (++++). Conclusion: Although there may be typical clinical presentation of Candidiasis. all the patients did not show laboratory evidence of infection. Pregnancy was found to be major risk factor for development of VVC. C. albicans was prevalent species but non albicans species were also frequently isolated. Extracellular phospholipase activity was seen in C. albicans and not in non albicans Candida isolates.
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Correlation between two chemiluminescence based assays for quantification of hepatitis B surface antigen in patients with chronic hepatitis B infection p. 96
E Gupta, P Pandey, A Kumar, MK Sharma, SK Sarin
DOI:10.4103/0255-0857.148400  PMID:25560010
Purpose: Hepatitis B surface Antigen (HBsAg) is the hallmark in diagnosing hepatitis B virus (HBV) infection. In India many commercial assays are available for detection of HBsAg but very few can measure it quantitatively. The present study presents the comparative evaluation of two methods and their correlation with serum HBsAg in chronic hepatitis B (CHB) patients. Materials and Methods: Consecutive patients of CHB were included and there HBsAg levels were measured by two methods: (i) Elecsys, Roche Diagnostics, a qualitative assay and (ii) Architect, Abbott Diagnostics, a quantitative assay. The HBV DNA was measured by real-time polymerase chain reaction (qPCR). Results: Total of 136 patients were included in the study and there was a significant overall correlation between both the assays (correlation coefficient [r] = 0.83; P < 0.001). Assays correlated well with each other across all subgroups of CHB: treatment naοve (r = 0.73; P < 0.001, n = 32), on treatment (r = 0.56; P < 0.05, n = 104), hepatitis Be (HBe) antigen positive (r = 0.67; P < 0.001, n = 62) and anti-HBe positive (r = 0.61; P < 0.05, n = 74) group. On correlation with serum HBV DNA, Architect assay demonstrated good correlation (r = 0.73; P < 0.001, n = 136) as compared to the Elecsys assay (r = 0.27; P = 0.068, n = 136). Architect HBsAg QT assay (A1) also correlated well with HBV DNA in the treatment naοve group (r = 0.69; P < 0.001, n = 32). Conclusions: Our study hence proved that both the assays are comparable and a simple qualitative assay with in-house modification can be used easily for quatitation of HBsAg in clinical samples.
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Anti-biofilm efficacy of silver nanoparticles against MRSA and MRSE isolated from wounds in a tertiary care hospital p. 101
MA Ansari, HM Khan, AA Khan, SS Cameotra, MA Alzohairy
DOI:10.4103/0255-0857.148402  PMID:25560011
Purpose: Different approaches have been used for preventing biofilm-related infections in health care settings. Many of these methods have their own de-merits, which include chemical-based complications; emergent antibiotic resistant strains, etc. The formation of biofilm is the hallmark characteristic of Staphylococcus aureus and S. epidermidis infection, which consists of multiple layers of bacteria encased within an exopolysachharide glycocalyx. Nanotechnology may provide the answer to penetrate such biofilms and reduce biofilm formation. Therefore, the aim of present study was to demonstrate the biofilm formation by methicillin resistance S. aureus (MRSA) and methicillin resistance S. epidermidis (MRSE) isolated from wounds by direct visualisation applying tissue culture plate, tube and Congo Red Agar methods. Materials and Methods: The anti-biofilm activity of AgNPs was investigated by Congo Red, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) techniques. Results: The minimum inhibitory concentration (MIC) was found to be in the range of 11.25-45 μg/ml. The AgNPs coated surfaces effectively restricted biofilm formation of the tested bacteria. Double fluorescent staining (propidium iodide staining to detect bacterial cells and fluorescein isothiocyanate concanavalin A (Con A-FITC) staining to detect the exopolysachharides matrix) technique using CLSM provides the visual evidence that AgNPs arrested the bacterial growth and prevent the glycocalyx formation. In our study, we could demonstrate the complete anti-biofilm activity AgNPs at a concentration as low as 50 μg/ml. Conclusions: Our findings suggested that AgNPs can be exploited towards the development of potential anti-bacterial coatings for various biomedical and environmental applications. In the near future, the AgNPs may play major role in the coating of medical devices and treatment of infections caused due to highly antibiotic resistant biofilm.
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Novel synthetic anti-fungal tripeptide effective against Candida krusei p. 110
K Gill, S Kumar, I Xess, S Dey
DOI:10.4103/0255-0857.148404  PMID:25560012
Introduction: Candida species are the major fungal pathogens of humans. Among them, Candida krusei have emerged as a notable pathogen with a spectrum of clinical manifestations and is known to develop resistance against azoles mainly fluconazole. Anti-microbial peptides play important roles in the early mucosal defence against infection and are potent anti-fungal agents since they fight against fungal infection as well as have ability to regulate host immune defence system. The aim of the study was to synthesize a small anti fungal peptide. Materials and Methods: The series of tripeptides were synthesized and screened for antifungal activity against Candida strains according to CLSI guidelines. Toxicity effect of peptide was tested with human erythrocytes. The mode of action of peptide on fungus was resolved by scanning electron microscopy (SEM) studies Results: The tripeptide FAR showed a prominent anti fungal activity among the series. The minimum inhibitory concentration and minimum fungicidal concentration of tripeptide FAR was found to be 171.25 μg/ml and 685 μg/ml, respectively against Candida krusei . The therapeutic index was 2.9. The haemolytic experiment revealed that this peptide is non - toxic to human cells. The SEM studies showed disruption of cell wall and bleb-like surface changes and irregular cell surface. Conclusion: The peptide showed a significant antifungal activity against C. krusei. Thus, it can set a platform for the design of new effective therapeutic agents against C. krusei.
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BRIEF COMMUNICATIONS Top

Outbreak of Burkholderia cepacia complex bacteremia in a chemotherapy day care unit due to intrinsic contamination of an antiemetic drug p. 117
T Singhal, S Shah, R Naik
DOI:10.4103/0255-0857.148405  PMID:25560013
Background: In the end of 2009, a large number of patients with cancer undergoing chemotherapy at the day care unit of a private hospital in Mumbai, India developed Burkholderia cepacia complex (BCC) blood stream infection (BSI). Objective: The objectives were to identify the source of the outbreak and terminate the outbreak as rapidly as possible. Materials and Methods: All infection control protocols and processes were reviewed. Intensive training was started for all nursing staff involved in patient care. Cultures were sent from the environment (surfaces, water, air), intravenous fluids, disinfectants and antiseptics and opened/unopened medication. Results: A total of 13 patients with cancer with tunneled catheters were affected with BCC BSI. The isolates were of similar antimicrobial sensitivity. No significant breach of infection control protocols could be identified. Cultures from the prepared intravenous medication bags grew BCC. Subsequently, culture from unused vials of the antiemetic granisetron grew BCC, whereas those from the unopened IV fluid bag and chemotherapy medication were negative. On review, it was discovered that the outbreak started when a new brand of granisetron was introduced. The result was communicated to the manufacturer and the brand was withdrawn. There were no further cases. Conclusions: This outbreak was thus linked to intrinsic contamination of medication vials. We acknowledge a delay in identifying the source as we were concentrating more on human errors in medication preparation and less on intrinsic contamination. We recommend that in an event of an outbreak, unopened vials be cultured at the outset.
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Fungal rhinosinusitis: A clinicomycological perspective p. 120
K Usha Krishnan, D Agatha, R Selvi
DOI:10.4103/0255-0857.148407  PMID:25560014
Purpose: Chronic rhinosinusitis (CRS) is a widely prevalent condition globally as well as in India. The spectrum of fungal involvement in CRS runs from benign colonisation to potentially life-threatening invasive disease. Successful treatment of such mycotic infections largely depends on the accurate identification of the pathogen, early and appropriate intervention by surgical clearance, supported with antifungal medication as per standard regimen. Thus, this study was undertaken to determine the prevalence of fungal rhinosinusitis (FRS), and to analyse its clinicomycological profile. Materials and Methods: Fifty-two patients with clinical suspicion of CRS attending a tertiary care hospital during a one-year period were included in this retrospective analysis. The sinonasal specimens were subjected to microscopy by KOH mount and fungal culture as per standard mycological technique. Tissue specimens were also subjected to histopathological examination. Results: Male to female ratio was 1.25:1; age varied from 14 years to 62 years with majority of patients (37%) belonging to age group 21-40 years. The prevalence of FRS was 44%, and 74% of it was caused by Aspergillus sp. Aspergillus flavus (A. flavus) (52%) was the most prevalent fungus isolated. Allergic fungal rhinosinusitis (AFRS) was the most common presentation (79%). Conclusion: FRS is a continuous spectrum of disease varying in presentation, treatment and long-term sequelae. Correct identification of the fungus remains essential for appropriate treatment.
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Hand hygiene in reducing transient flora on the hands of healthcare workers: An educational intervention p. 125
R Kapil, HK Bhavsar, M Madan
DOI:10.4103/0255-0857.148409  PMID:25560015
Aim: Hand hygiene has now been recognised as one of the most effective intervention to control the transmission of infections in a hospital and education is an important tool to ensure its implementation. In order to convince the users and as a part of education, it is important to generate evidence on the role of hand hygiene in reducing the bacterial flora on their hands. The present study was undertaken in a tertiary care hospital to demonstrate the presence of bacterial flora on the hands of healthcare workers (HCW) in different categories, to teach them proper hand hygiene technique using alcohol-based hand rub and determine the outcome for reduction of bacteria. Materials and Methods: A total sample size of 60 subjects including resident doctors, medical students, nurses and hospital attendants were included in the study after obtaining informed consent. Each person was educated on the technique of hand hygiene with alcohol-based hand rub and hand impressions were cultured before and after hand hygiene. All the subjects were also given a questionnaire to assess their perception on hand hygiene. The WHO posters on proper hand hygiene were displayed in the appropriate areas of the hospital in addition, as an educational tool. Results: Majority (42 out of 60) of the HCWs had bacterial count up to 100 colonies or more on both hands before the application of hand rub while working in the hospital. After use of alcohol hand rub with a proper hand hygiene technique, it was found that the percentage reduction was 95-99% among doctors and nurses, 70% among hospital attendants and 50% among sanitary attendants. Staphylococcus aureus was present on the hands of eight persons of which three were methicillin-resistant Staphylococcus aureus. Conclusions: The study demonstrates that transient bacteria are present on the hands of HCWs but majority could be removed by proper hand hygiene, which needs continuous education to be effective. It also shows that active education by demonstrating the proper hand hygiene technique and direct observation of the practices, though demanding, are ideal to understand the attitudes and practices of HCWs and helps in planning implementation strategies.
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Biomedical waste management: Study on the awareness and practice among healthcare workers in a tertiary teaching hospital p. 129
L Joseph, H Paul, J Premkumar, Rabindranath , R Paul, JS Michael
DOI:10.4103/0255-0857.148411  PMID:25560016
Bio-medical waste has a higher potential of infection and injury to the healthcare worker, patient and the surrounding community. Awareness programmes on their proper handling and management to healthcare workers can prevent the spread of infectious diseases and epidemics. This study was conducted in a tertiary care hospital to assess the impact of training, audits and education/implementations from 2009 to 2012 on awareness and practice of biomedical waste segregation. Our study reveals focused training, strict supervision, daily surveillance, audits inspections, involvement of hospital administrators and regular appraisals are essential to optimise the segregation of biomedical waste.
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A preliminary study of recombinant human interferon-α-2a activity against rabies virus in murine model p. 132
S Roy, D Patil, S Ghadigaonkar, R Roy, S Mukherjee, A Chowdhary, R Deshmukh
DOI:10.4103/0255-0857.148412  PMID:25560017
Rabies remains an important public health problem in the world due to uncontrolled enzootic rabies. Although rabies associated fatalities may be prevented with timely immunoprophylaxis, but till date a therapeutic molecule has remained elusive. We investigated the role of rhuIFN α-2a in murine model challenged with rabies virus. Titre of 10 4.25 LD 50 /0.03 ml of 10% w/v RV CVS stock suspension were obtained. Based on 1LD 50 titre, challenge dose of 50 LD 50 was administered along with rhuIFN α-2a with pre-exposure (primed) and post-exposure with the rabies virus. Both showed increased survival time as compared with the virus controls. These findings suggest that the rhuIFN α-2a might have some anti-viral activity, which can be used for the treatment of rabies infection. Further research on the efficacy of interferon along with anti-viral drugs for the treatment will be helpful in designing combination therapy against the disease.
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Phenotyping of Salmonella serotypes isolated from natural sources of water in rural areas of East Sikkim p. 136
S Poonia, TS Singh, DC Tsering
DOI:10.4103/0255-0857.148413  PMID:25560018
The objective of the study was to conduct bacteriological analysis of water with special reference to Salmonella spp from natural sources of rural habitations of East Sikkim. A total of 28 Salmonella serovars isolated were biotyped, phage typed and tested for their anti-microbial susceptibility. All the isolates of Salmonella enterica serovar Typhi belonged to Biotype I. Four isolates of S. typhi belonged to phage type A. All S. paratyphi A isolates belong to phage 2. All the isolates were sensitive to chloramphenicol, cefixime and amikacin. Untreated natural water sources are unsafe for human consumption.
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YnfA , a SMR family efflux pump is abundant in Escherichia coli isolates from urinary infection p. 139
SK Sarkar, A Bhattacharyya, SM Mandal
DOI:10.4103/0255-0857.148415  PMID:25560019
A quantitative study was undertaken to determine the expression level of different efflux pumps in multi-drug-resistant (MDR) Escherichia coli isolates from urinary infection. We have determined the presence of different efflux pumps and measured the expression level of tolC, mdfA, norE and ynfA genes among 48 isolates by quantitative real-time PCR. The expression level of tolC and ynfA was constantly high and observed among 75-80% of isolates, whereas mdfA and norE were expressed occasionally. Our findings suggest that ynfA, a new SMR efflux pump gene family member increases the antibiotics' resistance in E. coli.
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Emergence of influenza A (H1N1) PDM09 in the remote Islands of India - A molecular approach p. 143
N Muruganandam, D Bhattacharya, IK Chaaithanya, H Bhattacharya, R Reesu, A Maile, GSJ Bharathi, AP Sugunan, P Vijayachari
DOI:10.4103/0255-0857.148417  PMID:25560020
Background: A disease outbreak of A (H1N1) PDM09 was reported in Andaman and Nicobar islands in 2009 with an attack rate of 33.5% among settler population and 26.3% among the aboriginal Nicobarese tribe. During the ongoing outbreak of A (H1N1) PDM09 disease in different parts of the world, a subject working in Dubai city of Saudi Arabia, came to Port Blair, following which the pandemic triggered for the first time in these Islands. Materials and Methods: During the period August 2009 to January 2011, 30 confirmed cases of Influenza A (H1N1) PDM09 virus infection was detected. To understand the genetic relationship, the NA gene sequences of the viruses were phylogenetically analysed together along with the virus sequence isolated from other parts of the world. Result: Formation of multiple clusters were observed, with the sequences of Andaman Islands, mainland India, Mexico, Saudi Arabia and few other counties clustering together. The sequence analysis data revealed that there was no specific mutation conferring resistance to oseltamivir among the Andaman A (H1N1) PDM09 virus isolates. The result of phylogenetic analysis have also revealed that the A (H1N1) PDM09 virus might have spread in these remote Islands of India via the subject from Saudi Arabia/Dubai. Conclusion: A (H1N1) PDM09 Influenza outbreak have highlighted the need to strengthen the region-specific pandemic preparedness plans and surveillance strategies.
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COMMENTARY Top

GenoType  MTBDR assay for detection of rifampicin and isoniazid resistance p. 147
Viroj Wiwanitkit
PMID:25560021
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CASE REPORTS Top

Profile of fatal Streptococcal bacteraemia at a tertiary care Indian hospital p. 148
P Punia, N Bhardwaj, P Mathur, G Gupta, MC Misra
DOI:10.4103/0255-0857.148424  PMID:25560022
Streptococcus pyogenes causes mild to acutely life-threatening diseases. Herein, we report our experience with five cases of fatal bacteraemia due to various groups of Streptococci, three of them due to Group G Streptococcus and one case each due to Group A Streptococcus and Group F Streptococcus. The peculiarity of all these cases was the rapidity of deaths occurring in these patients despite all the strains being sensitive to Penicillin. Hence, timely intervention in all suspected cases is strongly advocated. All isolates of beta-haemolytic Streptococci should be identified up till the species level and antimicrobial susceptibility be performed so that proper and early management can be done.
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Diagnosis of primary hydatid cyst of thigh by fine needle aspiration cytology p. 151
KA Bothale, H Kolhe, SD Mahore, AR Wilkinson
DOI:10.4103/0255-0857.148426  PMID:25560023
Hydatidosis is a parasitic infestation caused by larval form of the tapeworm, Echinococcus granulosus. Primary hydatid cyst in the skeletal muscles and subcutaneous tissue of thigh without involving thoracic and abdominal organs is an exceptional entity, even in countries where the Echinococcus infestation is endemic. We report an unusual case of primary hydatid cyst of thigh in proximity to skeletal muscles. This case illustrates that echinococcal disease should be considered in the differential diagnosis of every subcutaneous cystic mass. This case is presented here for its rarity.
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Eosinophilic meningitis: A case series and review of literature of Angiostrongylus cantonensis and Gnathostoma spinigerum p. 154
I Shah, S Barot, M Madvariya
DOI:10.4103/0255-0857.148430  PMID:25560024
Eosinophilic meningitis is defined as the presence of >10 eosinophils/μL in cerebrospinal fluid (CSF) or at least 10% eosinophils in the total CSF leukocyte count. Eosinophilic meningitis has been reported in two case series and two case reports in India till date and has not been reported in children below 15 years of age. We present two children with eosinophilic meningitis with peripheral eosinophilia and the proposed etiologic agents based on the clinical setting and their response to antihelminthic agents.
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Hemophilus influenzae meningitis and septicaemia in a 14-month-old child after primary immunisation p. 158
B Tarai, N Ravishankar, P Vohra, P Das
DOI:10.4103/0255-0857.148431  PMID:25560025
We report a 14-month-male child, who developed Hemophilus influenzae meningitis after three primary doses of the vaccine. The child presented with fever and seizures. H. influenzae was isolated from both cerebrospinal fluid (CSF) and blood. The child also had features of septicaemia. Procalcitonin (104 ng/ml) and C-reactive protein (CRP - 42.6 mg/dl) were high. Appropriate antibiotics were given. The child made an uneventful recovery. This case highlights vaccine failure, especially after primary immunisation alone.
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Disseminated penicilliosis marneffei in immunocompetent patients: A report of two cases p. 161
Feng Ye, Qun Luo, Ying Zhou, Jiaxing Xie, Qingsi Zeng, Guoqin Chen, Danhong Su, Rongchang Chen
DOI:10.4103/0255-0857.148433  PMID:25560026
Disseminated penicilliosis marneffei is rarely seen in immunocompetent persons. We report here two cases of disseminated penicilliosis marneffei in immunocompetent hosts. Penicillium marneffei disseminated to the brain in one patient and to the bone marrow in the other patient. Both patients received amphotericin B liposome. The cases illustrate the importance of considering penicilliosis marneffei as causes of systemic infections in immunocompetent patients.
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Cutaneous fungal infection in a renal transplantation patient due to a rare fungus belonging to order Pleosporales p. 165
S Galipothu, U Kalawat, R Ram, C Kishore, AVSSN Sridhar, A Chaudhury, VS Kumar
DOI:10.4103/0255-0857.148435  PMID:25560027
Fungal infections are being increasingly reported from immuno-compromised as well as immuno-competent patients. Transplant patients are on long term immunosuppressive therapy which makes them highly vulnerable to opportunistic fungal infections .These infections can be cutaneous or systemic. Several fungi have been reported to be the culprits such as Candida spp., Aspergillus spp., C. neoformans, P. carinii, and zygomycetes group of fungi. Cutaneous infections are most commonly caused by Pityriasis (tinea) versicolor, dermatophytes, and candida sp but these days the demtiaceous fungi are becoming more frequently reported .Here we report a case of post renal transplant cutaneous infection caused by dematiaceous fungus belonging to the order Pleosporales
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Facial lupus vulgaris of bilateral periorbital skin and conjunctiva: A case report and brief review p. 168
S Verma, G Verma, V Shanker, GR Tegta, A Sharma, ML Pandey
DOI:10.4103/0255-0857.148438  PMID:25560028
A 22-year-old male presented to the Dermatology Department with bilateral plaque lesions distributed symmetrically over malar area, bridge of nose and upper eyelids progressing over 1 year 3 months. Lesion remained unhealed after antibiotic treatment. Microscopy and culture for fungal and mycobacterial infections were negative. The Mantoux test showed an exaggerated response and PCR was positive for Mycobacterium tuberculosis complex. Patient was treated successfully with anti-tubercular therapy.
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Shewanella algae in acute gastroenteritis p. 172
S Dey, D Bhattacharya, S Roy, SD Nadgir, A Patil, SD Kholkute
DOI:10.4103/0255-0857.148442  PMID:25560029
Shewanella algae is an emerging bacteria rarely implicated as a human pathogen. Previously reported cases of S. algae have mainly been associated with direct contact with seawater. Here we report the isolation of S. algae as the sole etiological agent from a patient suffering from acute gastroenteritis with bloody diarrhoea. The bacterium was identified by automated identification system and 16S rRNA gene sequence analysis. Our report highlights the importance of looking for the relatively rare aetiological agents in clinical samples that does not yield common pathogens. It also underscores the usefulness of automated systems in identification of rare pathogens.
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CORRESPONDENCE Top

New intensive care unit and bacterial epidemiology p. 176
SQ Yu, HQ Zhou, LJ Liu
DOI:10.4103/0255-0857.148414  PMID:25560030
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Hygiene practices and sexual activity associated with urinary tract infection in rural pregnant women of Nagpur, India p. 177
SS Thakre, SN Dhakne, SB Thakre, SN Ughade
DOI:10.4103/0255-0857.148416  PMID:25560031
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Diagnostic dilemma in hookworm infection: An unusual case report p. 179
B Sharma, S Mohapatra, AM Kumar, M Deb
DOI:10.4103/0255-0857.148418  PMID:25560032
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A preliminary study screening cephalosporin-resistant Enterobacteriaceae for blaCTX-M and blaampC isolated from Kumaun region, India p. 180
Umesh , M Shahid, V Rawat, HM Khan, A Singh, F Sobia
DOI:10.4103/0255-0857.148422  PMID:25560033
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Seroprevalence of coinfections among blood donors in tertiary health care centre of Jammu region p. 181
M Dogra, A Dogra, M Sidhu, U Kotwal
DOI:10.4103/0255-0857.148425  PMID:25560034
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Evaluation of new chromogenic media for identification of uropathogens from complicated urinary tract infections in a tertiary healthcare setting p. 183
B Mohan, P Gupta, SB Appannanavar, G Singh, N Taneja
DOI:10.4103/0255-0857.148427  PMID:25560035
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16S rRNA PCR for the diagnosis of culture-negative Bartonella quintana endocarditis: The importance of sample type p. 185
YT Chin, R Hasan, A Qamruddin
DOI:10.4103/0255-0857.148429  PMID:25560036
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Detection of various types of resistance patterns and their correlation with minimum inhibitory concentrations against clindamycin among methicillin resistant S. aureus isolates p. 187
S Arora, N Jindal, V Sharma
DOI:10.4103/0255-0857.148437  PMID:25560037
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Four year data from an ICTC of a tertiary care hospital in Jaipur, Rajasthan p. 187
ER Sabharwal
DOI:10.4103/0255-0857.148439  PMID:25560038
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Risk factors and genotypes of HCV infected patients attending tertiary care hospital in North India p. 189
N Jindal, R Bansal, P Grover, R Malhotra
DOI:10.4103/0255-0857.148440  PMID:25560039
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Carriage of quinolone resistance in faecal coliforms among healthy individuals: A study from northeast India p. 190
M Ajij, D Paul, A Bhattacharjee
DOI:10.4103/0255-0857.148441  PMID:25560040
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CTX-M and PER-1 group extended spectrum β-lactamases-producing Pseudomonas aeruginosa from the patients of lower respiratory tract infection p. 191
S Saxena, G Banerjee, R Garg, M Singh
DOI:10.4103/0255-0857.148444  PMID:25560041
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Cutaneous TB-presenting as recurrent non-healing sinuses p. 192
BK Madhusudhan, B Madhusudhan
DOI:10.4103/0255-0857.148445  PMID:25560042
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Dual infection of measles and rubella in chitradurga district, Karnataka, India p. 193
NJ Shaikh, CG Raut, DP Sinha, MJ Manjunath
DOI:10.4103/0255-0857.148446  PMID:25560043
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BOOK REVIEW Top

Medical microbiology for nurses p. 195
M Deb
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"Longitude prize:" Save the world and win 10 million sterling pounds!! p. 196
A Ghafur
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2004 - Indian Journal of Medical Microbiology
Published by Medknow

Online since April 2001, new site since 1st August '04