Humanity has been at the receiving end of many viral diseases since ages. Sudden emergence and re-emergence of new viral diseases in human beings has surprised the medical scientists from time to time. "Avian influenza" or "Bird flu" by H5N1 epidemics is one such surprise. Although many aspects about this disease are clear, there are some dark areas regarding vaccine development that need to be further explored and understood, so as to effectively contain the spread of this disease. The present article details out almost everything known about this interesting disease along with the review of the recent literature.

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Clinical grading and bacteriological study of 107 patients with diabetic foot lesions revealed polymicrobial aetiology in 69 (64.4%) and single aetiology in 21 (19.6%). Among 107 patients 62 had ulcer. Of these 31 had mixed aerobes. Twenty six patients with cellulitis and 12 with gangrene had more than 5 types of aerobes and anaerobes such as E.coli, Klebsiella spp., Pseudomonas spp., Proteus spp., Enterobactor spp., Enterococci spp., Clostridium perfringens, Bacteroides spp., Prevotella spp. and Peptostreptococcus spp. It was noted that 50 out of 62 patients with ulcer, and all the patients with cellulitis and gangrene were given surgical management and treated with appropriate antibiotics based on antimicrobial susceptibility testing.

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PURPOSE: Chromogenic media are increasingly being used as versatile tools in early differentiation and identification of bacterial isolates from clinical specimens. We have evaluated the Urichrome II, a newly introduced chromogenic medium, for its utility as a primary isolation and identification medium for urinary microbial isolates. MATERIALS: This study included 5497 consecutively collected midstream and/or catheter catch urine samples obtained from patients attending several clinical services. They were inoculated on blood, MacConkey, cystine lactose electrolyte deficient, and Urichrom II agar plates for isolation of uropathogens. RESULTS: The Urichrom II medium allowed the growth, and primary identification, of the predominant uropathogens like E.coli, Klebsiella spp. and Enterobacter spp. (KES group). The different coloured colonies produced by the breakdown of the chromogenic substrates by the specific enzymes of the bacteria were very useful in the presumptive identification of these organisms even from mixed cultures by the colour differences of the colonies. The medium also supported growth and differentiation of gram positive organisms like Staphylococcus aureus and enterococci. CONCLUSIONS: Urichrom II can be used as a primary culture medium for predominant uropathogens like E.coli, KES group and enterococci. It is an easy to use primary screening medium that considerably reduces the daily workload and thus minimizes or limits the use of identification tests.

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Malassezia spp. are lipophilic unipolar yeasts recognized as commensals of skin that may be pathogenic under certain conditions. The genus Malassezia now comprises of seven species. This study was aimed at using a simple practical approach to speciate Malassezia yeasts from clinical material. Seventy skin scrapings from patients with pityriasis versicolor infection, positive in 10% potassium hydroxide (KOH), were cultured onto modified Dixon's agar (mDixon's agar) and Sabouraud dextrose agar (SDA) and incubated at 32ºC. Speciation was done on the basis of Gram stain morphology, catalase test, and utilization of Tweens. Out of 70 scrapings 48 (68.75%) showed growth on mDixon's agar. The commonest isolate was M. sympodialis (28, 58%) followed by M. globosa (19, 40%) and one isolate was (2%) of M. restricta. M. sympodialis was the commonest species affecting our population and there was no isolation of M. obtusa, M. slooffiae, M. pachydermatis and M. furfur.

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A total of 411 urinary isolates (353 Escherichia coli and 58 Klebsiella pneumoniae) were studied for extended spectrum -lactamase (ESBL) production by double disk approximation test and NCCLS confirmatory test. ESBL production was found to be 41% in E.coli and 40% in K.pneumoniae. Fourteen percent and 12% of ESBL producers showed false susceptibility to ceftazidime and cefotaxime in routine susceptibility testing. The susceptibility of ESBL producers to imipenem, nitrofurantoin and amikacin was found to be 100%, 89% and 86% respectively. A high degree of associated resistance to gentamicin, co-trimoxazole and quinolones was found in ESBL producers. Majority of ESBL producers was detected among patients admitted in medical ICU and surgery ward.

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PURPOSE: The objective of this prospective pilot study was to estimate serum C3 levels and complement activation within 12 hours of injury and to correlate them with abbreviated injury score (AIS) so as to predict the outcome of injury in terms of mortality or sepsis. METHODS: The test group (n=30) of patients with < 12 hours of injury were assessed by the AIS-80 and compared with a control group (n=10). Serum C3 levels were estimated by the single radial immunodiffusion technique and complement activation by both two-dimensional and counter immuno-electrophoresis. Statistical analysis was performed using the correlation regression analysis and the minimum discrimination information statistics (MDIS) analysis. RESULTS: Serum C3 levels were not reduced in patients with injury severity score (ISS) < 12 (n=7). There was a statistically significant difference of serum C3 levels in patients with ISS between 12 and 29 (n=15) and in patients with ISS more than 29 (n=9). Complement activation also correlated well with ISS (p <0.05). Complement activation and serum C3 levels were found to influence subsequent development of septic complications in the post injury period, being significantly lower in patients who developed septic complications. Complement alterations in trauma patients were a direct result of the trauma since they were not seen in patients undergoing surgery. CONCLUSIONS: ISS is a good prognosticator of outcome of trauma and serum C3 levels and complement activation are good predictors for mortality and development of septic complications in recently injured patients. These may prove to be effective parameters in the management of the patients with injury.

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Ten multidrug resistant (MDR) isolates of Pseudomonas aeruginosa, obtained from hospitalized burn patients, were selected for plasmid detection, curing and transformation experiments. These isolates were also studied for plasmid mediated resistance. All the isolates were found to harbour R plasmid. Curing and transformation experiments showed that resistance to amikacin was plasmid mediated. -lactamase production was also tested. It is suggested that plasmids should be characterised in all MDR P. aeruginosa strains and a nation wide antibiotic policy should be made to minimise the emergence of drug resistance.

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Cryptococcal meningitis is recognized as one of the AIDS defining conditions. It acts as a diagnostic marker for further investigations to establish the retroviral infection. Cryptococcus neoformans can be readily identified by its characteristic capsulated morphology. But rarely variations in morphology may be seen. We report a case of chronic meningitis in an AIDS patient whose cerebrospinal fluid (CSF) stained with India ink showed elliptical, peanut shaped and pseudomycelial large yeast cells with thick capsules. The organism was cultured and identified as Cryptococcus neoformans var neoformans. Unusual morphological forms may create diagnostic dilemma in the rapid diagnosis of cryptococcal meningitis.

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Cladophialophora bantiana (Xylohypha bantiana) is a dematiaceous fungus with distinct neurotropism. CNS phaeohyphomycosis due to C. bantiana is an uncommon infectious condition and is associated with high mortality. We report this rare clinical entity in a 22-year-old male, presenting as brain abscess. Etiological diagnosis was made based on fungal culture and histopathological examination. Complete surgical resection of the lesion and treatment with antifungal agents could not save the patient from this frequently fatal infection.

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Since susceptibility of a cell line is an important factor for cultivation of Chlamydia trachomatis, McCoy, HeLa, BHK-21, HEp-2, Vero and A549 cell lines were tested for this characteristic. These were inoculated with 150 infection-forming units (IFU) of C. trachomatis A, B, Ba and C serovars. Growth was graded according to the number of IFUs per microscopic field (100X). A549-cell line was not susceptible to infection by any of the serovars. The growth of C. trachomatis was good to very good in McCoy and HeLa cell lines. Vero, BHK-21 and HEp-2 cell lines varied considerably in the susceptibility to infection.

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The aim of this study was to perform pyrazinamide (PZA) susceptibility testing of M.tuberculosis by enzymatic PZA assay and compare the results with radiometric BACTEC 460 TB system and LJ proportion method. One hundred and thirty clinical isolates of M.tuberculosis were included in the study. Of the 130 clinical isolates tested, five were resistant and 124 were sensitive by both methods thus giving overall sensitivity and specificity of 83.33% and 100% respectively. Concordance was found in 129 out of 130 strains tested by all three methods. Pyrazinamidase assay can be used as an alternative to BACTEC and LJ proportion method.

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A 3-month-old male child with the history of fever, of not sucking the breast and exhibiting\symptoms of meningitis was brought to the hospital for medical advice and was investigated. Aeromonas hydrophila was isolated thrice from CSF, blood samples as well as the water source.

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Chlamydia trachomatis is currently recognized as one of the most common sexually transmitted pathogen and a major cause of perinatally acquired infection. Vertical transmission of infection from mother to the infant may result in the development of conjunctivitis and pneumonia. The study was conducted with the aim of determining the prevalence of C. trachomatis pneumonia and to identify its clinical manifestations. Nasopharyngeal aspirates were collected from 50 infants (4-24 weeks of age) with pneumonia. C. trachomatis was detected in nasopharyngeal aspirates by direct fluorescent antibody (DFA) staining. Using DFA, C. trachomatis was found in 12.5% of infants. C. trachomatis pneumonia was associated with the age group of 4-12 weeks, cough of more than 7 days duration, presence of conjunctivitis, milder grade of pneumonia and absence of fever. The study showed a high prevalence of C. trachomatis pneumonia in infants.

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PURPOSE: To assess the impact of HIV infection on emergency medicine department services. METHODS: The demographic and clinical data of all the HIV reactive individuals admitted to the emergency medicine department (EMD) were analyzed by reviewing the case records retrospectively. RESULTS: Of the 1187 HIV reactive cases detected during a period of 10 years, 435 cases were admitted to the EMD. 90% of the patients were unaware of their HIV reactive status. Prolonged perplexing pyrexia was the commonest presentation (73.4%) followed by Tuberculosis (53%). Neurological complications, AIDS enteropathy were also seen to rise over the years. Road traffic accidents/polytrauma/an acute cardiac event contributed to 7.6% of the cases who otherwise had no symptoms related to the HIV infection. CONCLUSIONS: The rate of increase in HIV reactivity, among the patients presenting to the EMD assumes significance as they could potentially transmit HIV infection to the health care personnel following exposure to body secretions of the patient during resuscitation. The study emphasizes the importance of stringent practice of universal precautions irrespective of the HIV status by all health care workers at all levels, especially in the EMD.

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