PURPOSE: The objective of the present study was to delineate the differences between the clinical and environmental Aeromonas species with respect to their biochemical characteristics, serogrouping and virulence factors, in order to find a phenotypic marker of enteropathogenicity. METHODS: A total of 55 Aeromonas spp. inclusive of 19 isolates from cases of diarrhoea, and 36 from water samples comprising, 10 isolates of A. hydrophila, 21 isolates each of A. sobria, and A. caviae, two isolates of A. jandaei and one isolate of A. veronii were subjected to analysis of their biochemical characteristics, serogrouping, and virulence factors. RESULTS: Among the differences recorded in the biochemical characteristics in the three major species, the most striking characteristic was fermentation of lactose, which was observed in all the 11 A. caviae isolates recovered from water samples. None of the 10 clinical isolates of A. caviae tested fermented lactose. The clinical Aeromonas isolates belonged to seven typable serogroups, O:13, O:14, O:16, O:21, O:27, O:32 and O:35. The environmental isolates belonged to eight different serogroups, such as, O:3, O:11, O:14, O:16, O:18, O:28, O:64 and O:78 and were predominated by serotypes O:18 and O:64. Among the virulence factors tested, 89% of the environmental isolates produced b haemolysin, while only 62.3% of clinical isolates were able to do so. There was no significant difference between the clinical and environmental aeromonads with respect to their enterotoxigenicity in suckling mice in vivo, cytotoxicity in vitro in Vero cell monolayers, and ability to produce siderophores. CONCLUSION: Efforts to delineate the differences between the clinical and environmental Aeromonas spp. did not reveal significant difference between them. However, difference was observed with respect to their ability to produce b haemolysin, wherein, higher percentage of environmental isolates was haemolytic. The results also suggest that all the haemolytic environmental isolates need not be enteropathogenic. Further, serogroups O:18 and O:64 may not be involved in aeromonal diarrhoea in children in this geographic region.

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A cross-sectional study was undertaken to find out co-prevalence of various infectious markers like Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Syphilis infection amongst a cohort of injecting drug users (IDUs) in the city of Delhi. A total of 246 IDUs were enrolled during the 3 months period of the study. The results revealed a high prevalence of the viral markers studied i.e., HBV-39.59%, HCV-36.45%, HIV-36.99% and Syphilis-6.09%. A single marker infection was detected amongst 9.14% for HBV, 8.37% for HCV, 4.87% for HIV and 0.83% for Syphilis in samples tested for multiple markers. All the four markers could be detected in 1.76%. Amongst 11.16% and 27.9% of these samples, three and two markers respectively could be detected. The study revealed the problem of IV drug use and high prevalence of infectious markers including HIV in certain populations of Delhi and emphasizes the need for relevant interventions in these localised pockets.

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PURPOSE: To study the epidemiological characteristics of bacterial keratitis seen at a tertiary eye care referral centre in south India. METHODS: A retrospective review of medical records of all culture-positive bacterial keratitis which were seen over a 3 years period, from September 1999 through August 2002 was performed. After clinical evaluation corneal scrapings were collected and subjected to culture and microscopy using standard protocols in all patients. RESULTS: Out of 3183 corneal ulcers evaluated, 1043(32.77%) were found to be of bacterial aetiology. A total of 1109 bacterial pathogens were isolated from 1046 eyes with keratitis. The predominant bacterial species isolated was Streptococcus pneumoniae (37.5%). Males were 592(56.76%) and 451(43.24%) were females. There were 564(54.07%) rural residents and 479(45.93%) urban residents; this difference was statistically significant (p< 0.0001). Patients with age more than 50 years (60.2%) were affected significantly more than patients aged less than 50 years (30.8%). While 57.62% of patients were non-agricultural workers, 42.38% were farmers; this difference was statistically significant (p<0.0001). Co-existing ocular diseases predisposing to corneal ulceration were identified in 703(67.4%) patients, compared to other predisposing risk factors in 340(32.6%) patients. One hundred and seventy seven (16.97%) had corneal injury with soil and/or sand, compared to 115(11.03%) patients who had injury due to other materials and the difference was statistically significant. There was lower incidence of bacterial keratitis from June to September. CONCLUSIONS: The epidemiological characteristics of bacterial keratitis vary geographically. This study describing the features of bacterial keratitis would greatly help the practising ophthalmologist and other medical practitioners in the management of their patients.

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PURPOSE: Wound infection is an important cause of morbidity and occasional mortality after coronary artery bypass graft surgery (CABG). The aim of this study was to report postoperative wound infection in CABG surgery patients. METHODS: Consecutive patients undergoing CABG surgery between January 1998 and October 1999 have been studied. The exclusion criteria included, age less than 30 years, penicillin / cephalosporin allergy and associated other cardiac pathologies. The parameters studied were age, sex, obesity, hypertension, diabetes, myocardial infarction, chronic renal failure, previous surgeries, alcohol consumption, smoking, length of pre and postoperative hospital stay, antibiotic prophylaxis, MRSA screening, and duration of surgery. Wounds were classified as per modified CDC's NNIS criteria. Suspected sites of infection were cultured and antibiotic susceptibility of cultured organisms was tested. Postoperative follow up was for two months. RESULTS: Six hundred and fifteen patients were studied. Of these 116 (18.86%) developed SSI, involving sternum 75%, leg 21.3%, and forearm sites 3.44%. Organisms isolated at sternum site were MSSE, MRSA, and MRSE, at leg site E. coli and MSSE, and at forearm site MSSE and MSSA. Sternal site, obesity, diabetes mellitus and female sex were associated with significantly higher infection rates (p= 0.001). No antibiotic protocol proved more effective. SSI increased the postoperative hospital stay and the total treatment cost. CONCLUSIONS: Post CABG surgery SSI rate is high. Sternum and leg are the common infection sites. Obesity, uncontrolled diabetes mellitus and female sex are associated with higher infection rates. "Higher" antibiotics do not lower postoperative infection rates.

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Cryptococcus neoformans produces brown colonies on Niger seed (Guizotia abyssinica) agar. Media containing caffeic acid, L-dopa and other diphenolic compounds, have been used for the same purpose. The present report describes a new medium containing tobacco which supports growth of C.neoformans and allows its easy differentiation by formation of brown coloured colonies.

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Human immunodeficiency virus (HIV) is known to influence the natural history of infections with certain hepatitis viruses and interactions between HIV and hepatitis viruses may potentiate HIV replication. There is high degree of epidemiological similarity between hepatitis B virus and HIV as regard to high-risk group and route of transmission. Transmission of hepatitis C virus (HCV) through blood transfusion and intravenous drug abuse is well documented. Present study deals with the study of concurrent infection of HBV and HCV with HIV infection. In the study of 110 HIV seropositive patients, 34(30.4%) were positive for HBV and 8(7.27%) for HCV. The difference of concomitant infection was highly significant compared to controls. (p value < 0.0001). Heterosexual high risk behaviour was observed in 89(80.91%) of 110 HIV positive patients, out of which 23(25.8%) and 5(5.62%) were HBsAg and anti-HCV positive respectively. History of transmission was unclear in remaining patients. Concomitant infection of HIV and HBV was found to be significantly more in the symptomatic group (40.68%) compared to asymptomatic group (19.6%). As HIV infection is known to affect the natural history of both HBV and HCV infection, screening of their concurrent association is necessary.

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Two hundred and twenty seven patients were included in the study. The test group included 55 patients of pyrexia of unknown origin (PUO), 42 veterinary workers, 38 hepatitis patients and 25 village farmers. The control group comprised of 27 Syphilis controls and 40 healthy controls. Of the total study entrants, 186 were tested for Leptospira antibodies by IgM ELISA and 41 by microscopic agglutination test (MAT). ELISA results of 45 patients were further tested by MAT for comparative evaluation. Out of 160 patients of the test group 56(35.0%) were positive for Leptospira antibodies. The positivity was 18(32.73%) amongst PUO patients, 15(35.71%) of the farm workers, 15(39.47%) of hepatitis patients and 8(32.0%) farmers. Leptospira antibodies were not detected in any of the controls. The antibody positivity was seen in 33(32.04%) of the 103 urban patients and 23(40.35%) of 57 rural patients. Out of 56 Leptospira cases, in 39(69.64%) history of animal contact was present. The common clinical features in these patients included fever in 51(91.07%), myalgia 48(85.71%), headache 42(75.0%), Anorexia 31(55.35%), Jaundice 24(42.86%) and nausea/vomiting in 21(37.5%). Of the 45 ELISA results compared with that of MAT, there was 86.67% agreement between the tests.

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The present study reports the prevalence of HIV infection among the drug addicts undergoing counselling and treatment in a drug deaddiction centre located in Bhubaneswar, during July 1996 to August 1997. All subjects were males. The coded serum samples were tested by ELISA and rapid spot test for the detection of HIV antibodies. The positive samples were finally confirmed by the line immunoassay for HIV infection. A high prevalence of 7% HIV infection was noticed among the drug addicts (n=100). Oral drug abusers and IDUs were positive for HIV-1 infection in 5.26% and 21.74% cases respectively. The present study reveals a high prevalence of HIV infection among the drug addicts for the first time from Orissa which needs a careful monitoring and surveillance.

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Currently, antiretroviral therapy has become more affordable even in developing countries and it is being used in India. Fifteen HIV-1 infected individuals, who were on highly active antiretroviral therapy (HAART), were followed up for an average period of one year. The plasma viral load and CD4+ T cell estimation done at mean intervals of 5 months and 11 months after initiation of therapy showed a good response to therapy in 14 (93%) individuals.

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PURPOSE: One hundred and ten Helicobacter pylori isolates from peptic ulcer disease patients and matched controls were analysed for any possible relationship between the presence of cryptic plasmids and their antibiotic sensitivity pattern. METHODS: Antral biopsies of patients with gastric and duodenal ulcer, gastric cancer, non ulcer dyspepsia and matched controls were cultured for H.pylori. Antibiotic susceptibility and MIC analysis of the clinical isolates was done by E-test. Plasmid profiles of the isolates were analysed using mini ultra prep plasmid kit. RESULTS: Out of the 110 isolates tested, 89.1% isolates were resistant to metronidazole, 10.9 % were resistant to clarithromycin and 0.9% were resistant to multiple drugs. Isolates harbouring plasmids were seen in all the groups and constituted 5.4% of total isolates. CONCLUSIONS: The presence of plasmids in the clinical isolates of H.pylori did not have any correlation with their antibiotic resistance pattern.

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Nocardiosis has been recognized in recent times as an unusual opportunistic infection associated with HIV. Bacteraemia due to this pathogen is even rarer and only few cases have been reported in the literature. We report here a case of pulmonary nocardiosis with bacteraemia, which was initially diagnosed as pulmonary tuberculosis. A high index of suspicion is required to diagnose this infection as the clinical presentation and radiographic features mimic pulmonary tuberculosis.

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Blood bank regulations and bio medical waste rules of India advocate disinfection of contaminated blood units. Incineration is not recommended due to poly-vinyl chloride (PVC) content of blood bags. This study was designed to evaluate the efficacy of chemical disinfection of blood units deliberately contaminated with Staphylococcus aureus and E. coli with 1 and 6 % hypochlorite, 10% formalin and 33% formaldehyde and autoclaving of blood units contaminated with the above mentioned vegetative forms and B. stearothermophilus spores. Only 33 % formaldehyde could bring about 5 log reduction of bacteria but it is highly irritating and toxic. Autoclaving at 15 lbs pressure for 2 hours uniformly inactivated the vegetative forms and B. stearothermophilus spores. Thus, autoclaving of PVC blood bags is a safer and reliable method compared to chemical disinfection.

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The human immunodeficiency virus (HIV) epidemic is still in its early stages, and a marked increase in global prevalence is projected for the next coming years. Neither behavioural therapies nor current antiretroviral drugs are likely to have an impact on this silent epidemic. Current antiretroviral drugs are too expensive for the developing countries, and there are major problems of adherence, resistance and toxicity, which limit their application and efficacy. The main problem facing us, as inhabitants of a single world, is to prevent further infections regardless of where they occur, and this requires a vaccine programme. A successful immunotherapeutic HIV vaccine has the potential to overcome these problems, and would be a valuable advance. To accelerate the development of an HIV vaccine, additional candidate vaccines must be evaluated in parallel in both industrialized and developing countries. This will require international collaboration and coordination and critical ethical issues will need to be addressed. The probable triple cocktail of the future for global HIV prevention will be vaccination, anti-retroviral therapy, and not the least, behavioural therapy.

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PURPOSE: To compare a commercially available Latex agglutination test and an in house co-agglutination test for the detection of cryptococcal antigen in cases of chronic meningitis. METHODS: One hundred and fifty cerebrospinal fluid (CSF) samples from 150 cases of chronic meningitis were tested for the presence of Cryptococcus neoformans by modified India ink, culture and antigen detection by latex agglutination test (LAT) and co-agglutination (Co-A) test. RESULTS: Thirty-nine cases were positive by one or more tests employed. Antigen detection in CSF by LAT and Co-A was found to be most sensitive (94.9%) while culture was the least (25.6%). Of the two antigen detection methods, Co-A was found to be more sensitive than the LAT, the difference being statistically significant. Initial CSF antigen titres did not have any prognostic significance. CONCLUSIONS: Co-A for antigen detection is an inexpensive and useful adjunct to direct microscopy and culture for the diagnosis of cryptococcal meningitis, though its usefulness in prognosis needs to be evaluated further.

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Ralstonia mannitolilytica is being increasingly identified as an opportunist pathogen in immunocompromised patients. We report the first case of post renal transplant infection by R. mannitolilytica, in a 14-year-old recipient. The graft and the patient were saved with prompt microbiological identification, sensitivity testing and subsequent administration of appropriate antibiotic.

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