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  ~ Table of Contents - Current issue
Coverpage
July-September 2015
Volume 33 | Issue 3
Page Nos. 341-469

Online since Friday, June 12, 2015

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EDITORIAL  

Gonococcal antimicrobial resistance p. 341
S Sood
DOI:10.4103/0255-0857.158531  PMID:26068331
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ORIGINAL ARTICLE Top

Free living amoebae in water sources of critical units in a tertiary care hospital in India p. 343
S Khurana, M Biswal, H Kaur, P Malhotra, P Arora, K Megha, N Taneja, R Sehgal
DOI:10.4103/0255-0857.158543  PMID:26068332
Background: Isolation of free-living amoebae (FLA) is reported sparsely from water taps, ventilators, air conditioners, haemodialysis units and dental irrigation systems of hospitals worldwide. Their prevalence in hospital environment especially in wards having immunocompromised patients may pose a risk to this group of susceptible population as they may cause disease themselves or may carry pathogens inside them. No study from India has performed such surveillance. Objective: To evaluate extent of FLA contamination in water sources of bone marrow transplant (BMT) intensive care unit (ICU), transplant ICU, haemodialysis unit and high dependency unit in a tertiary care hospital in India. Materials and Methods: A total of hundred samples including fifty each of tap water samples and swabs from mouth of taps used for drinking, bathing and hand washing purposes in these units were collected according to standard procedure. Samples were inoculated onto non-nutrient agar plates at room temperature followed by morphological confirmation. Molecular identification including polymerase chain reaction (PCR) and sequencing was performed in culture positive samples. Results: Four tap water samples and ten swab samples showed growth of trophozoites and cyst formation. Morphologically, four amoebae resembled Acanthamoeba spp. which was further confirmed by PCR and sequencing showed them to be of T3 and T4 genotypes. Conclusion: The presence of these FLA in hospital water sources emphasises the urgent need of implementing effective preventive measures. Further studies are required to estimate the true prevalence of FLA in Indian hospitals by taking larger number of samples.
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COMMENTARY Top

Free living amoebae: Acanthamoeba species pose a great risk for human health p. 349
B Kocazeybek
PMID:26068333
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ORIGINAL ARTICLES Top

Molecular characterization of clinical isolates of Cyclospora cayetanensis from patients with diarrhea in India p. 351
P Yadav, S Khalil, BR Mirdha, GK Makharia, S Bhatnagar
DOI:10.4103/0255-0857.158547  PMID:26068334
Purpose: Cyclospora cayetanensis is an intestinal coccidian protozoan that has emerged as an important cause of both epidemic and endemic protracted diarrhea worldwide. Though humans appear to be the only natural hosts; the role of animals as natural reservoir is uncertain but of increasing concern. The present study aimed to study the prevalence of coccidian in different groups such as immunocompromised, clinically apparent immunocompetent and healthy individuals. Also, the study isolates were assessed for heterogeneity among the sequences. Materials and Methods: Stool samples from different groups of patients were collected. The parasite was detected in stool by different diagnostic tools such as light microscopy and nested PCR-restriction fragment length polymorphism using 18S ribosomal RNA as the target gene. Results: The prevalence of C. cayetanensis was 2.4% (19/800) in the present study. The PCR assay amplified Cyclospora cayetanensis DNA in only 89% (17/19) isolates. Further, sequencing revealed no significant difference among the study isolates and the non-primates. Phylogenetic analysis of the study isolates however, formed two clusters. While one cluster showed close evolutionary association with the C. cayetanensis strains, the other cluster showed evolutionary association with the two non-primate species. Conclusion: The methods described here for detection of C. cayetanensis oocysts are simple, efficient, specific, and sensitive and therefore can be effectively applied for laboratory diagnosis and environmental assessment of fresh produce and water sources. Clinicians should include Cyclospora infection in the differential diagnosis of prolonged or relapsing diarrheal illness even in clinically apparent immunocompetent individuals.
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Intestinal microsporidiosis in renal transplant recipients: Prevalence, predictors of occurrence and genetic characterization p. 357
U Ghoshal, S Khanduja, P Pant, KN Prasad, TN Dhole, RK Sharma, UC Ghoshal
DOI:10.4103/0255-0857.158551  PMID:26068335
Purpose: Intestinal microsporidiosis, which occurs in immunocompromised states such as acquired immunodeficiency syndrome, has rarely been studied in patients with renal transplantation (RT) on immunosuppressive therapy. Materials and Methods: Three hundred and twenty-four consecutive RT recipients on immunosuppressive treatment and 170 healthy subjects were evaluated for intestinal microsporidiosis and other parasites by modified trichrome staining, wet mount using normal saline, iodine and polymerase chain reaction (PCR). Clinical, demographic and laboratory parameters associated with occurrence of intestinal microsporidiosis were studied using univariate and multivariate analysis. The species of microsporidia were studied using PCR-restriction fragment length polymorphism (RFLP). Patients were treated with albendazole (400 mg twice daily for 2 weeks). Results: Of 324 RT recipients initially screened, 52 were excluded from final analysis due to incomplete data. Patients with RT [n = 272, age 42 ± 12.54 years, 222 (81.6%) male] more often had microsporidiosis than healthy subjects by modified trichrome stain and PCR [n = 170, age 33.8 ± 6.7 years, 123 (72.3%) male] [16/272 (5.8%) vs. 0/170 (0%), P < 0.001]. Patients with intestinal microsporidiosis were younger (33.9 ± 8.3 years vs. 42.3 ± 12.6 years; P = 0.009), had diarrhoea more often (13/16, 81% vs. 123/256, 48%; P = 0.02), which was longer in duration (60, 32.5-105 days vs. 12, 6.2-18 days; P < 0.001) and had associated giardiasis (2/16, 12.5% vs. 2/256, 0.8%; P = 0.018). Younger age, presence of diarrhoea and associated giardiasis were significant on multivariate analysis. Enterocytozoon bieneusi was detected in 15/16 (93%) patients with intestinal microsporidiosis. Conclusion: Intestinal microsporidiosis occurs frequently in patients with RT on immunosuppressive treatment, particularly among younger patients with longer diarrhoea duration and associated giardiasis. E. bieneusi is the major species identified among these patients.
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Fasciolopsiasis: Endemic focus of a neglected parasitic disease in Bihar p. 364
A Achra, P Prakash, R Shankar
DOI:10.4103/0255-0857.158554  PMID:26068336
Purpose: To describe a newly discovered, previously unreported endemic focus of fasciolopsiasis in the Phulwaria village, under tehsil Sugauli, East Champaran, Bihar. Materials and Methods: A study was conducted at village Phulwaria, following diagnosis of fasciolopsiasis in three children from the village. A total of 120 individuals, including all the children and adults who gave history of recent passage of red fleshy masses in their stool, were included in the study. The cases of fasciolopsiasis were treated with Praziquantel 25 mg/kg, three doses a day. Risk factors for the transmission of the parasite in the village were also studied. Results: Questionnaire revealed majority of the population suffering from abdominal discomfort and passage of red fleshy masses in stool. These fleshy masses were identified as Fasciolopsis buski. One hundred and eighteen individuals were presumably considered as cases of the parasitic infection. After treatment with Praziquantel, all of them passed the parasite in their stool for the next 2-3 days. On investigating, it was observed that all the conditions required for effective continuation of the life cycle of the parasite were present in this village. Conclusion: This study draws attention to a new endemic focus of fasciolopsiasis in Bihar, with a very high prevalence due to poverty, the lack of awareness about the parasite in villagers as well as ignorance among local medical practitioners. There is an urgent need for mass campaign around the region for its effective control.
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Frequency of Epstein - Barr virus infection as detected by messenger RNA for EBNA 1 in histologically proven gastric adenocarcinoma in patients presenting to a tertiary care center in South India p. 369
ML Rymbai, VV Ramalingam, I Samarasan, BS Chandran, G Mathew, J Jerobin, AM Abraham, J Sachithanandham, R Kannangai
DOI:10.4103/0255-0857.158556  PMID:26068337
Background: Epstein-Barr virus (EBV)-associated gastric carcinoma is a relatively uncommon entity detected in approximately 10% of gastric adenocarcinoma. Objective: The purpose of this study is to estimate the frequency of EBV-associated gastric carcinoma and also to assess the nature of presentation, any significant difference between this subgroup and EBV-negative gastric adenocarcinomas with respect to age and sex predilection, lymph nodal status, site of presentation. Materials and Methods: We prospectively analyzed 100 cases of gastric adenocarcinoma who underwent either a partial or total gastrectomy during the period from March 2010 to August 2011. The tumour and the corresponding normal gastric tissue from the same patient were analyzed for the presence of Epstein-Barr nuclear antigen 1 (EBNA1) messenger ribonucleic acid (mRNA) by real-time polymerase chain reaction (PCR). Result: EBV was detected in 6% cases of gastric adenocarcinoma. All the positive patients were males. The majority of cases involved the proximal stomach and there was variable lymph nodal involvement. Conclusion: Our study endorses that there is an association between EBV infection and gastric adenocarcinoma in the Indian population. There was no significant difference between this subgroup and EBV-negative gastric adenocarcinomas with respect to age and sex predilection, lymph nodal status and site of presentation. Short-term follow-up of this subgroup of patients seems to indicate a good overall prognosis after appropriate treatment. However, a larger study with long-term follow-up is needed to further establish the role of EBV in gastric adenocarcinoma in this study population.
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Detection of clarithromycin-resistant Helicobacter pylori strains in a dyspeptic patient population in Sri Lanka by polymerase chain reaction-restriction fragment length polymorphism p. 374
NL Ubhayawardana, MM Weerasekera, D Weerasekera, K Samarasinghe, CP Gunasekera, N Fernando
DOI:10.4103/0255-0857.158557  PMID:26068338
Aim: The aim of this study was to investigate the proportion of common clarithromycin-resistant mutation types present in the 23S ribosomal ribonucleic acid (rRNA) gene of H. pylori strains in Sri Lanka. Settings and Design: The study was a cross-sectional, descriptive study where 76 dyspeptic patients who were required to undergo endoscopy examination were included. The study was carried out at a Teaching Hospital in Sri Lanka. Subjects and Methods: In-house urease test and polymerase chain reaction (PCR) amplification of the glmM gene of H. pylori was performed to confirm the H. pylori infection. Analysis of point mutations in 23S rRNA gene strains were performed by PCR-restriction fragment length polymorphism (RFLP). Results: Of the 16 urease-positive biopsies, 94% (n = 15) were positive by PCR using the glmM primer. All H. pylori strains yeilded a point mutation at A2142G site of the 23S rRNA gene, while A2143G mutation was not detected. Conclusions: For the first time in Sri Lanka, we reported predominance of A2142G point mutation associated with claritromycin resistance of H. pylori in a Sri Lankan population.
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Mumps disease outbreak in Davangere district of Karnataka, India p. 378
CG Raut, DP Sinha, H Jayaprakash, H Hanumiah, MJ Manjunatha
DOI:10.4103/0255-0857.158558  PMID:26068339
Background: Mumps is a vaccine-preventable disease that usually occurs as a parotitis, but it can also lead to several life- threatening complications, including pancreatitis, meningitis and encephalitis. Objective: To determine and diagnosis of mumps disease, which is communicable disease usually affects childrens. Although it is seen worldwide, but outbreaks not common in India. Materials and Methods: Thirty one suspected mumps cases, who presented to the unimmunized population of Chikkahallivana village in Davangere district of Karnataka, India in January 2014, with clinical evidence of fever, cervical lymphadenitis and ear pain, manifest with self-limited uni-or bilateral parotitis. A total of 31 cases consisting of 31 blood and 31 throat swabs were tested for diagnosis of mumps disease. Results: Of the 31 suspected cases, laboratory results showed 18 positive for mumps IgM antibodies and 7 cases showed presence of mumps virus RNA by RT-PCR using MV specific nested primers. From 31 cases, 5 were positive with both the methods. Conclusion: We confirmed the cases by serological as well as a sensitive RT-nested PCR-based method and sequencing results for the molecular identification of mumps infection. Sequencing results of the SH gene identified outbreak strain as genotype C, which was consistent with other outbreaks in India.
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Safe transportation of biomedical waste in a health care institution p. 383
A Kumar, S Duggal, R Gur, SR Rongpharpi, S Sagar, M Rani, D Dhayal, CM Khanijo
DOI:10.4103/0255-0857.158559  PMID:26068340
Introduction: The chances of health care waste (Biomedical waste) coming in contact with the health care workers, patients, visitors, sanitary workers, waste handlers, public, rag pickers and animals during transportation are high. Materials and Methods: The study was conducted over a period of seven months (April 2013-October 2013) in a 500-bedded hospital where the average quantum of biomedical waste is 0.8 kg/bed/day. The issues related to transportation of health care waste from 39 generation sites to the health care waste storage site inside the hospital (intramural transfer) were addressed and analysed in a predesigned proforma. Results: The biomedical waste management team inspected the generation sites in the hospital on a daily basis and conformance to the procedures was checked. It was found that waste was collected at scheduled timings in 99.6% occasions; however, compliance to wearing personal protective equipment (PPE) was poor and ranged from 1.22−1.84%. Conclusion: Transportation of health care waste is a crucial step in its management. Regular training program for all the sections of health care workers with special emphasis on waste handlers is needed.
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Mutations at embB306 codon and their association with multidrug resistant M. tuberculosis clinical isolates p. 387
A Gupta, SK Singh, S Anupurba
DOI:10.4103/0255-0857.158560  PMID:26068341
Purpose: The presence of embB306 mutation in ethambutol (EMB)-susceptible (EMBs) clinical isolates questions the significance of these mutations in conferring resistance to EMB. The present study was carried out to determine the occurrence of embB306 mutation in EMB-resistant (EMBr) and EMBs strains of M. tuberculosis. One hundred and four multidrug-resistant tuberculosis (MDR-TB) strains were also included to establish the relevance of excessive use of rifampicin (RIF) and isoniazid (INH) in occurrence of embB306 mutations in EMBs M. tuberculosis isolates. Materials and Methods: Deoxyribonucleic acid (DNA) from M. tuberculosis clinical strains was isolated by cetyltrimethylammonium bromide (CTAB) method. Phenotypic and genotypic drug susceptibility testing (DST) was performed on 354 M. tuberculosis isolates by using standard proportion method and multiplex-allele-specific polymerase chain reaction assay, respectively. Results: The overall frequency of embB306 mutations in EMBr isolates was found to be five times higher than its occurrence in EMB-susceptible isolates (50% vs 10%). Further, the association between embB306 mutation and EMB-resistance was observed to be statistically significant (P = 0.000). Conclusion: The embB306 is not only the main causative mutation of EMB resistance, but is a sensitive applicant marker for EMB-resistance study.
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Adverse drug reactions profile of antimicrobials: A 3-year experience, from a tertiary care teaching hospital of India p. 393
Richa , VR Tandon, S Sharma, V Khajuria, V Mahajan, Z Gillani
DOI:10.4103/0255-0857.158564  
Aim of Study: To evaluate adverse drug reaction (ADR) profile of antimicrobials over 3-year period. Material and Methods: A retrospective cross-sectional study was undertaken using suspected adverse drug data collection form available under Pharmacovigilance Programme of India (PvPI). Results: A total of 2,586 ADR events were recorded in 3 years, out of which 392 (15.15%) were because of antimicrobials. Male: female was 1.02:1. Medicine department contributed maximally (98.97%). The intravenous (IV) route of drug administration accounted maximum ADRs (53.32%), followed by oral route (45.41%). Monotherapy was responsible for 80.87%, whereas combination therapy for 19.13%. Combinations therapy was irrational in 79.67%. The most common antibiotic resulting in ADRs was injection ceftriaxone (35.71%), followed by tab. azithromycin (7.39%), tab. ofloxacin + ornidazol (5.35%), ofloxacin (3.57%), ciprofloxacin (2.29%), amoxicillin (2.55%), tab. cefixime (2.29%), inj. linezolid (2.04%). Rash remained the most common ADR, followed by diarrhoea and gastritis. Most common organ system involved was dermatological (47.44%), followed by gastrointestinal (GI) (39.28%), central nervous system (CNS) (5.35%), cardiovascular system (CVS) (3.57%) and renal and genitourinary (1.78%). While 47.96% ADR's were latent, 26.785% were acute and 25.26% were sub-acute. Moreover, 89.79% of ADRs were moderate in nature, whereas 26.88% were severe and 3.33% mild in nature. Furthermore, 92.86% were non-serious and 7.14% serious in nature. Also, 65.06% of antimicrobial caused ADRs were type A and 34.64% were type B reactions. As per World Health Organization-The Uppsala Monitoring Centre (WHO-UMC) scale, 73.98% of ADRs were probable/likely and 26.02% as possible. However, 99.47% of ADRs required intervention. Conclusion: The current study suggest that ADRs due to antimicrobials is a significant health problem.
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BRIEF COMMUNICATIONS Top

Population genetic study of Plasmodium falciparum parasites pertaining to dhps gene sequence in malaria endemic areas of Assam p. 401
J Sharma, P Dutta, SA Khan
DOI:10.4103/0255-0857.158565  PMID:26068343
Plasmodium falciparum malaria parasite had developed resistance to almost all the currently used antimalarial drugs. The purpose of the study was to come across the genetic distances in P. falciparum dhps gene sequences circulating in Assam. A partial fragment of P. falciparum dhps gene containing major single nucleotide polymorphisms associated with sulphadoxine resistance were amplified and sequenced. Thereafter specific bioinformatics tools like BioEdit v7.0.9, ClustalW in Mega 5, DnaSP version v.5.10.01 etc were used for the analysis. A total of 100 P. falciparum positive cases in different malaria endemic areas of Assam were included for the study. Based upon the mutation analysis, a total of seven different P. falciparum dhps genotypes were observed with five variable sites. Maximum five haplotypes were found in the P. falciparum isolates from Jorhat district of Assam. Four polymorphic sites were observed in the P. falciparum dhps gene sequences in Karbi Anglong, NC Hills, Chirang and Jorhat whereas the isolates from other study areas had three polymorphic sites. A statistically significant positive value of Tajima's D were observed among the P. falciparum field isolates in Assam indicating that there is an excess of intermediate frequency alleles and can result from population bottlenecks, structure and/or balancing selection. Extensive gene flow took place among the P. falciparum population of Jorhat with Sivasagar, Chirang with Sivasagar and Chirang with Karbi Anglong. However, large genetic differentiation was observed among the P. falciparum isolates of NC Hills with Lakhimpur, Tinsukia, Dibrugarh and Golaghat and also the parasite population of Karbi Anglong with Lakhimpur and Tinsukia signifying little gene flow among the population. This finding has shown that mutant Pfdhps gene associated with sulphadoxine resistance is circulating in Assam. It is believed that, the parasite population may have undergone high level of breeding.
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Measles outbreak investigation in Dwarahat block of District Almora, Uttarakhand p. 406
STM Hashmi, AK Singh, V Rawat, M Kumar, AK Mehra, RK Singh
DOI:10.4103/0255-0857.158567  PMID:26068344
Background: We report an assessment of measles outbreak during the months of February 2014 to April 2014 in Dwarahat block of district Almora and the response mounted to it. Materials and Methods: An intensive door-to-door search to six measles affected villages in Dwarahat block of district Almora, covering a population of 2,408 was carried out to identify the cases of measles by a rapid response team (RRT). A total of ten blood samples were randomly collected for detecting IgM antibody against measles. For all cases, information on personal details, place of residence, time of onset and status of immunization were obtained. Results: Overall attack rate (AR) was 2.8%. AR among the population of age-group 0-16 was 7.2%. Statistically significant higher AR (16.26%) was seen for the age-group of 0-5 years as compare to 6-10 and 11-16 years of age (AR-8.71, relative risk-0.53, 95% confidence interval-0.32-0.88, P value-0.012 and AR-0.57%, relative risk-0.035, 95% confidence interval-0.00-0.14, P value-0.000, respectively). Males were affected more often than females 35 [59.2%] vs. 24 [40.8%]. Measles-related complications were seen in three children. No death was reported. Of the 10 samples, nine were positive for measles IgM antibodies by enzyme-linked immunosorbent assay (ELISA). Conclusion: The recognition of early warning signals, timely investigation and application of specific control measures can contain the outbreak. The unvaccinated or partially protected human beings serve as the reservoir of measles virus. Hence, there is a need for sero surveillance for measles in Uttarakhand and one catch up measles immunisation campaign to prevent future outbreak.
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Asymptomatic reproductive tract infections/sexually transmitted infections among HIV positive women p. 410
S Bhattar, P Bhalla, D Rawat, R Tripathi, R Kaur, K Sardana
DOI:10.4103/0255-0857.158568  PMID:26068345
This study aims to highlight the importance of screening all HIV positive women for various reproductive tract infections/sexually transmitted infections (RTIs/STIs) irrespective of symptoms and to determine its occurrence in asymptomatic HIV positive women. Relevant specimens were collected for diagnosis of various RTIs/STIs. STIs were diagnosed in nearly one-third of the HIV positive asymptomatic patients which is quite high. The national strategy for STIs/RTIs control misses out large number of asymptomatic RTIs/STIs in HIV positive women which is responsible for silently transmitting these infections in the community. So this strategy should be modified to include screening of all HIV positives women irrespective of symptoms of STIs/RTIs.
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Fluconazole susceptibility of 3,056 clinical isolates of Candida species from 2005 to 2009 in a tertiary-care hospital p. 413
Y Ying, J Zhang, SB Huang, FD Liu, JH Liu, J Zhang, XF Hu, ZQ Zhang, X Liu, XT Huang
DOI:10.4103/0255-0857.158569  PMID:26068346
In recent years, Candida infections have been increasing significantly. This study was to investigate the distribution and fluconazole susceptibility of such infections. Totally, 3,056 clinical isolates were analysed, C. albicans was the most prevalent species from respiratory and vaginal specimens. However, non-albicans species constituted the majority of isolates from blood, urine, intensive care unit (ICU), organ transplant and burned patients. Similarly, Candida spp. from different specimens and clinical services had different degrees of susceptibility to fluconazole. Isolates from vagina and burned patients had the highest resistance rate, while all of the isolates from ascites and dermatological services were susceptible to fluconazole.
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An evaluation of dark field microscopy, culture and commercial serological kits in the diagnosis of leptospirosis p. 416
M Bhatia, BL Umapathy, BV Navaneeth
DOI:10.4103/0255-0857.158570  PMID:26068347
Context: This study was conducted to analyze the clinical utility of various leptospira diagnostic modalities. Aims: To evaluate the role of dark field microscopy (DFM), culture, immunochromatography (IgM Leptocheck), IgM enzyme-linked immunosorbent assay (IgM ELISA), macroscopic slide agglutination test (MSAT) and microscopic agglutination test (MAT) in diagnosing leptospirosis in febrile patients. Settings and Design: Descriptive study conducted in a tertiary care hospital from January 2011 to April 2012. Subjects and Methods: Blood, urine and paired sera from 100 patients with clinical suspicion of leptospirosis (study group) were collected and subjected to DFM, culture, IgM Leptocheck, IgM ELISA and MSAT. Fifty randomly selected sera from febrile patients tested positive for infections other than leptospirosis (control sera) were also subjected to the aforementioned serological assays. All the leptospira seropositive samples were subjected to MAT. Statistical Analysis Used: Positive predictive values (PPV) and coefficient of agreement (kappa). Results: None of the clinical samples showed positivity by DFM. Leptospira inadai was isolated from a urine sample. The seropositivity of IgM Leptocheck, IgM ELISA and MSAT was 16%, 46% and 47%, respectively. The PPV of these assays was 14.3%, 8.7% and 6.5%, respectively. Poor agreement was obtained among these assays. Only four study group leptospira seropositive samples were confirmed by MAT with Australis being the predominant serovar. None of the leptospira-positive control sera were confirmed by MAT. Conclusions: DFM and culture have limited utility in diagnosing leptospirosis with serology being the mainstay. The present study shows discordant results with the commercially available serological kits. Further studies should be done to evaluate the various diagnostic modalities.
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Detection of flea-borne Rickettsia species in the Western Himalayan region of India p. 422
R Chahota, SD Thakur, M Sharma, S Mittra
DOI:10.4103/0255-0857.158572  PMID:26068348
Human infections by various rickettsial species are frequently reported globally. We investigated a flea-borne rickettsial outbreak infecting 300 people in Western Himalayan region of India. Arthropod vectors (ticks and fleas) and animal and human blood samples from affected households were analysed by gltA and ompB genes based polymerase chain reaction (PCR). Rat flea (Ceratophyllus fasciatus) samples were found harbouring a Rickettsia sp. Phylogenetic analysis based on gltA gene using PHYLIP revealed that the detected Rickettsia sp. has 100% identity with SE313 and RF2125 strains of Rickettsia sp. of flea origin from Egypt and Thai-Myanmar border, respectively and cf1 and 5 strains from fleas and lice from the USA. But, the nucleotide sequence of genetically variable gene ompB of R14 strain was found closely related to cf9 strain, reported from Ctenocephalides felis fleas. These results highlight the public health importance of such newly discovered or less recognised Rickettsia species/strains, harboured by arthropod vectors like fleas.
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COMMENTARY Top

Predatory journals p. 426
NC Jain
DOI:10.4103/0255-0857.158573  PMID:26068349
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CASE REPORTS Top

Ascariasis as a cause of hepatic abscess: A report of 3 cases p. 427
V Chauhan, S Thakur, B Rana
DOI:10.4103/0255-0857.158576  PMID:26068350
We receive around 60 cases of hepatic abscess in a year. The commonest diagnosis reached at the time of discharge is amoebic liver abscess. The diagnosis of amoebic liver abscess is mostly presumptive and thus the patients are usually given a mixed treatment with injection ceftriaxone and tablet metronidazole. Here we report three cases of hepatic abscess diagnosed recently, where ascariasis was the probable etiology. Ascariasis may be a much commoner cause of hepatic abscesses in this region than we think.
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Isolation of Brucella melitensis from a human case of chronic additive polyarthritis p. 429
R Chahota, A Dattal, SD Thakur, M Sharma
DOI:10.4103/0255-0857.158578  PMID:26068351
Brucellar arthritis remains under diagnosed owing to non-specific clinical manifestations. Here, we report isolation of Brucella melitensis from synovial fluid of 5 th metatarsophalangeal joint of a 39-year-old lady having unusually chronic asymmetric, additive, peripheral polyarthritis. This isolation was confirmed by Bruce-Ladder polymerase chain reaction (PCR). The patient had a history of contact with an aborted goat. Rose Bengal Plate Agglutination Test (RBPT) and Standard Tube Agglutination Test (SAT) were positive for Brucella-specific antibodies both for patient and in contact with sheep and goats. The patient was treated with doxycycline and rifampicin for 16 weeks and was recovered fully.
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Prolonged remission in a child with chronic myeloid leukemia following Parvo virus B19 (B19V) infection p. 432
A Kumar, N Roy Moulik, J Kishore, A Kumar, A Jain
DOI:10.4103/0255-0857.158580  PMID:26068352
Parvovirus B19 (B19V) has been associated with a wide spectrum of clinico-pathological disorders in human beings depending upon the host immunity. The present report describes a child with chronic myeloid leukemia ( CML) on hydroxyurea in haematological remission, who developed profound erythroid suppression following B19V infection requiring multiple transfusions and withdrawal of hydroxyurea. Despite being off-therapy the child remained in complete clinical and haematological remission till anti B19V antibodies appeared. This case illustrates the ability of B19V infection in suppressing neoplastic myeloid clone, a phenomenon not described earlier.
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Onychoprotothecosis: An uncommon presentation of protothecosis p. 435
NR Gandham, CR Vyawahare, N Chaudhaury, RA Shinde
DOI:10.4103/0255-0857.158583  PMID:26068353
Onychomycosis is a fairly common condition seen in a dermatology clinic. Dermatophytes Trichophyton and Epidermophyton are the known filamentous fungi implicated. The yeast-like fungi such as Candida less commonly cause Onychomycosis. The genus Prototheca may on preliminary observation resemble yeast-like fungi but a detailed microscopy will reveal the absence of budding and presence of endospores. Onychoprotothecosis is an uncommon presentation of human protothecosis. Of the two Prototheca species (Prototheca zopfii and Prototheca wickerhamii) known to cause the disease, P. wickerhamii has been reported more commonly. We report a culture proven case of this condition caused by P. zopfii. The patient, a 55-year-old housewife presented with discolouration and breaking off of the right thumb and forefinger nails since a period of six months. Samples of nail scrapping sent to the Microbiology Laboratory were culture-positive for Prototheca. Speciation by the automated Vitek-2 system (bioMerieux) identified the isolate as P. zopfii, which was further confirmed at PGI, Chandigarh.
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Kluyvera ascorbata sepsis in an extremely low birth weight infant p. 437
D Sharma, T Dasi, S Murki, TP Oleti
DOI:10.4103/0255-0857.158585  PMID:26068354
Kluyvera ascorbata belongs to Enterobacteriaceae family and is a gram negative micro-organism. This bacteria is usually considered a commensal, however it can cause significant infections rarely. This organism is usually resistant to most commonly used antibiotics used as first line in neonatal units. Antimicrobial agents active against Kluyvera strains include third-generation cephalosporins, fluoroquinolones, and aminoglycosides. We report a case of an extremely low birth weight male infant who presented on day 4 of life with clinical features of sepsis, multi-organ dysfunction, shock and pulmonary haemorrhage. Neonatal sepsis was associated with marked elevation of C-reactive protein and a falling platelet count. Infant expired on day 5 of life in spite of aggressive supportive care and treatment with meropenem. with growth of Kluyvera ascorbataon blood culture.
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Pancytopenia and cutaneous cryptococcosis as an indicator disease of acquired immune deficiency syndrome p. 439
R Khuraijam, P Lungran, K Yoihenba, RS Laishram, P Pukhrambam
DOI:10.4103/0255-0857.158586  PMID:26068355
We present a case of pancytopenia and cutaneous cryptococcosis in a young girl with no complaints of fever, headache and vomiting. Fine-needle aspiration cytology and further investigation for pancytopenia revealed presence of Cryptococcus in skin and bone marrow aspirates. Fungal cultures of the skin aspirates, blood and bone marrow confirmed cryptococcal infection. Counselling and human immunodeficiency virus (HIV) test revealed the status of the patient to be retropositive. Although meningitis is the commonest manifestation of cryptococcosis among HIV-infected patients, rare cutaneous manifestation with pancytopenia but with no meningeal signs indicate the HIV status in an endemic area of penicilliosis, Manipur.
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Hydatid cyst of bone p. 442
F Babitha, PV Priya, U Poothiode
DOI:10.4103/0255-0857.158587  PMID:26068356
Hydatid disease is an extremely uncommon differential diagnosis in the cystic/lytic lesions of bone. We present a rare case of echinococcal infection of femur which presented as pathological fracture in a middle-aged female and diagnosis was confirmed by histopathology. Hydatid disease of bone is often asymptomatic, and its diagnosis is usually made when lesions have become extensive.
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Problems in the diagnosis of profound trichophytosis barbae p. 444
D Kozielewicz, J Wernik, A Mikucka, A Ciesielska, E Kruszynska, E Gospodarek, M Pawlowska, W Halota
DOI:10.4103/0255-0857.158591  PMID:26068357
Zoophilic species of human dermatophytoses, such as Trichophyton mentagrophytes are significantly rare. We present a case of a 42-year-old male who for 2 months had been unsuccessfully treated and then referred to hospital with suspected actinomycosis. Lesions on the skin on his neck, submandibular area, cheeks and groins were consistent with extremely painful, merging inflammatory tumours and infiltrations with the presence of numerous pustules in hair follicles that poured purulent contents forming into yellow crusts after compression. The treatment with terbinafine was successful. The final identification of the Trichopyton mentagrophytes var. granulosum strain was performed based on a microscopic assessment of the culture, and the result of species identification was confirmed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis.
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Seronegative invasive gastro-intestinal cytomegalovirus disease in renal allograft recipients a diagnostic dilemma! - Tissue PCR the saviour? p. 447
A Kaul, D Bhadauria, V Agarwal, V Ruhela, A Kumar, S Mohendra, S Barai, N Prasad, A Gupta, RK Sharma
DOI:10.4103/0255-0857.158596  PMID:26068358
Seronegative Invasive Gastro-intestinal cytomegalovirus disease in renal allograft recipients Background -CMV as oppurtunistic infection affecting the gastrointerstinal tract is the most common cause for tissue invasive CMV disease occuring in 10-30% of organ transplant recepients. Gastrointerstinal CMV disease can be diagnosed in presence of clinical suspecion along with histopathological findings (CMV inclusions) and presence of mucosal lesion(s) on endoscopic examination with collaborative evidences via molecular technique. Aims-Few cases of CMV infection affecting the gastrointerstinal tract show no evidences of dissemintion despite use of highly sensitive molecular techniques. We encountered 6 cases where in despite strong clinical suspecion of Gastrointerstinal CMV disease there were seronegative and endoscopic negative evidences for CMV, blind tissue biopsy yeilded positive results for CMV disease with excellent improvement with antiviral therapy. Conclusions-Blind biopsy specimen for tissue PCR could serve as saviour in an immunocompromised individiual who has a strong clinical symptomatology for GI-CMV disease in absence of viremia, normal endoscopy and histopathology, so that the early therapeutic interventions could help in excellent patient and graft survival.
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CORRESPONDENCES Top

Wound infection by Salmonella Typhi in a spinal injury patient without underlying osteomyelitis p. 453
N Rajkumari, P Mathur, K Farooque, V Sharma
DOI:10.4103/0255-0857.158597  PMID:26068359
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Detection of Chikungunya virus from a case of encephalitis, Bangalore, Karnataka State p. 454
NJ Shaikh, CG Raut, DP Sinha, MJ Manjunath
DOI:10.4103/0255-0857.158600  PMID:26068360
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Study of virulence factors in association with antimicrobial resistance amongst urinary isolates of enterococci p. 455
K Tiwari, T Banerjee, J Filgona, S Anupurba
DOI:10.4103/0255-0857.158602  PMID:26068361
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Inducible clindamycin resistance among staphylococcus aureus isolates in a tertiary care hospital of Assam p. 456
C Phukan, GU Ahmed, PP Sarma
DOI:10.4103/0255-0857.158603  PMID:26068362
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Higher incidence of dengue in Theni district, South India p. 458
M Amudhan, R Sekar, M Sivashankar, G Azagar Raja, S Ganesan, M Mythreyee
DOI:10.4103/0255-0857.158605  PMID:26068363
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Co-infections with chikungunya and dengue viruses: A serological study in Karnataka State, India p. 459
N Shaikh, CG Raut, M Manjunatha
DOI:10.4103/0255-0857.158607  PMID:26068364
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Tigecycline-resistant staphylococcal isolates in a tertiary care centre p. 461
S Basireddy, M Singh, S Ali, V Kabra
DOI:10.4103/0255-0857.158608  PMID:26068365
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Fungal keratitis in north India; Spectrum and diagnosis by Calcofluor white stain p. 462
MK Gupta, A Chandra, P Prakash, T Banerjee, OPS Maurya, R Tilak
DOI:10.4103/0255-0857.158609  PMID:26068366
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Hemorrhagic encephalitis caused by Mycoplasma pneumoniae in an 11-year-old boy: A rare case report p. 463
S Kumar, S Kapoor, SR Saigal
DOI:10.4103/0255-0857.158610  PMID:26068367
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In vitro activity of ceftaroline against methicillin-resistant Staphylococcus aureus isolates p. 464
S Basireddy, M Singh, S Ali, V Kabra
DOI:10.4103/0255-0857.158612  PMID:26068368
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RESEARCH SNIPPETS Top

Snippet p. 466
P Desikan
DOI:10.4103/0255-0857.158613  PMID:26068369
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ERRATUM Top

Nasal carriage of Methicillin-resistant Staphyloccocus aureus among healthy population of Kashmir, India: Erratum p. 469

DOI:10.4103/0255-0857.158614  PMID:26068370
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2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

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