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   2006| April-June  | Volume 24 | Issue 2  
 
 
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GUEST EDITORIAL
Re-emergence of Chikungunya virus in India
V Ravi
April-June 2006, 24(2):83-84
DOI:10.4103/0255-0857.25175  PMID:16687855
  134 28,862 1,810
ORIGINAL ARTICLE
Treatment of enteric fever in children on the basis of current trends of antimicrobial susceptibility of Salmonella enterica serovar typhi and paratyphi A
V Manchanda, P Bhalla, M Sethi, VK Sharma
April-June 2006, 24(2):101-106
DOI:10.4103/0255-0857.25182  PMID:16687859
Purpose: Recent reports indicate decreased susceptibility of S. typhi to fluoroquinolones, especially ciprofloxacin. Chloramphenicol has been suggested as first line therapy of enteric fever in many studies. This is a prospective study that describes the trends of antimicrobial susceptibility of S. typhi and S. paratyphi A causing bacteraemia in children and reports therapeutic failure to ciprofloxacin and evaluates the possible use of chloramphenicol, ampicillin, ciprofloxacin and third generation cephalosporins as first line therapy in the treatment of enteric fever in children. Methods: The present study was conducted from April 2004 to March 2005 in a superspeciality children hospital at New Delhi. A total of 56 S. typhi and five S. paratyphi A isolates were obtained among the 673 blood cultures performed. Antimicrobial testing was done using disk diffusion technique (NCCLS method) for 13 antimicrobials and MICs were calculated for ampicillin, ciprofloxacin, chloramphenicol and cefotaxime. Analysis of data was done using WHONET software. Results: All 56 isolates of S. typhi were sensitive to amoxycillin+clavulanate, gentamicin, cefixime, cefotaxime and ceftazidime. Multidrug resistance (MDR, resistance to three drugs) was seen in 22 cases (39%) and resistance to five drugs was seen in 12 cases (21%). Only two isolates were resistant to chloramphenicol (3%). MIC 90 for ampicillin, chloramphenicol, ciprofloxacin and cefotaxime were 1.0 mg/ml, 4.0 mg/ml, 64 mg/ml and 0.125 mg/ml respectively. All S. paratyphi A isolates were sensitive to ampicillin and chloramphenicol and resistant to nalidixic acid.MIC distribution data for chloramphenicol revealed elevated MIC but still in susceptible range. Conclusions: There is an urgent need for further clinical studies to evaluate response to chloramphenicol in such cases. Antimicrobial susceptibility data and MIC distribution favour use of ampicillin as a drug of choice for the treatment of enteric fever. Third generation cephalosporins are also useful but their use should be restricted for complicated cases.
  27 12,537 1,045
BRIEF COMMUNICATIONS
Comparison of double disc and three dimensional methods to screen for ESBL producers in a tertiary care hospital
T Menon, D Bindu, CPG Kumar, S Nalini, MA Thirunarayan
April-June 2006, 24(2):117-120
DOI:10.4103/0255-0857.25192  PMID:16687862
Extended spectrum β lactamases (ESBLs) continue to be a major problem in clinical setups world over, conferring resistance to the expanded spectrum cephalosporins. An attempt was made to study ESBL production among Enterobacteriaceae members from a tertiary care center in Chennai. A total of seventy randomly collected isolates of the family Enterobacteriaceae from a tertiary care center was studied for their susceptibility patterns to various antibiotics and detection of ESBL producers by double disc synergy (DDS) test and three dimensional test (TDT). Eighty percent of the isolates were multidrug resistant (MDR) and 20% were ESBL producers. TDT detected 85.7% whereas only 14.2% were detected by DDS. In the present study, a large number of isolates were found to be MDR and ESBL producers. TDTs were found to be better than DDS in the detection of ESBLs. Continued monitoring of drug resistance is necessary in clinical settings for proper disease management.
  21 7,659 702
ORIGINAL ARTICLE
The role of quantitative cultures of non-bronchoscopic samples in ventilator associated pneumonia
T Rajasekhar, K Anuradha, T Suhasini, V Lakshmi
April-June 2006, 24(2):107-113
DOI:10.4103/0255-0857.25226  PMID:16687860
Purpose: The objective of this study is to determine the role of quantitative cultures of non-bronchoscopic samples such as blinded bronchial sampling (BBS) and endotracheal aspirates (ETA) in the management of ventilator associated pneumonia (VAP). The study also evaluates the clinical diagnosis of VAP based on the inclusion of Gram stain results of BBS/ETA samples into modified clinical pulmonary infection score (CPIS). Methods: Fifteen out of the 120 patients admitted to respiratory intensive care unit under mechanical ventilation for more than 48 hours with a clinical suspicion of VAP, were included in this study. Quantitative cultures of BBS and ETA were performed from all the 15 patients. Results: VAP was confirmed in 11 out of 15 cases by quantitative cultures of either the BBS or ETA samples. The condition of 8/11 VAP confirmed patients improved significantly with the change in antibiotic therapy. The overall mortality rate was found to be 18%. The agreement between BBS and ETA results was found to be 83.3%. Modified-clinical pulmonary infection score (CPIS) increased significantly when Gram stain results of BBS/ETA samples were included, thereby strengthening the clinical diagnosis of VAP. Conclusions: Quantitative culture of lower respiratory tract samples obtained by non-bronchoscopic methods may be a useful alternative to bronchoscopy, in the diagnosis of VAP. Inclusion of Gram stain results of BBS/ETA into modified-CPIS may augment the diagnostic evaluation of VAP.
  11 10,962 643
CORRESPONDENCE
Change in serotype and appearance of tetracycline resistance in V. cholerae O1 in Vellore, South India
MV Jesudason
April-June 2006, 24(2):152-153
DOI:10.4103/0255-0857.25224  PMID:16687878
  11 2,568 177
SPECIAL ARTICLE
The effects of biocides (antiseptics and disinfectants) on the endospores of Rhinosporidium seeberi
SN Arseculeratne, DN Atapattu, P Balasooriya, R Fernando
April-June 2006, 24(2):85-91
DOI:10.4103/0255-0857.25176  PMID:16687856
No data exists on the activity of biocides (antiseptics and disinfectants) on Rhinosporidium seeberi that causes rhinosporidiosis in humans and animals. On account of the inability to culture R. seeberi, in vitro , dyes were used to assess the morphological integrity and viability of biocide-treated endospores that are considered to be the infective stage of this pathogen. Evan's Blue (EvB) identifies the morphological integrity of the endospores while MTT (3-[4, 5-dimethylthiazol-2yl]-2, 5-diphenyl tetrazolium bromide) identifies metabolic activity through its reduction by cellular dehydrogenases to microscopically visible deposits of insoluble formazan. MTT-negativity has earlier been shown to correlate with absence of growth of yeast and mycelial fungi in culture and could thus indicate the loss of viability of MTT-negative rhinosporidial endospores. Hydrogen peroxide, glutaraldehyde, chloroxylenol, chlorhexidine, cetrimide, thimerosal, 70% ethanol, iodine in 70% ethanol, 10% formalin, povidone-iodine, sodium azide and silver nitrate were tested on freshly-harvested endospores and all biocides caused metabolic inactivation with or without altered structural integrity as shown by absence of MTT-staining after 3, 24 or 36 hour after exposure, while EvB stained only the endospores treated with sodium azide, ethanol, thimerosal, chloroxylenol, glutaraldehyde and hydrogen peroxide. With clinically useful biocides - chlorhexidine, cetrimide-chlorhexidine, 70% ethanol, povidone-iodine and silver nitrate, a total period of exposure of endospores to the biocide, for seven minutes, produced metabolic inactivation of the endospores. Anti-rhinosporidial antiseptics that could be used in surgery on rhinosporidial patients include povidone-iodine in nasal packs for nasal and naso-pharyngeal surgery, chlorhexidine and cetrimide-chlorhexidine on the skin, while povidone-iodine and silver nitrate could have application in ocular rhinosporidiosis.
  7 10,732 316
REVIEW ARTICLES
Microbiological diagnosis of streptococcal pharyngitis: Lacunae and their implications
KN Brahmadathan, P Gladstone
April-June 2006, 24(2):92-96
DOI:10.4103/0255-0857.25178  PMID:16687857
Post-streptococcal sequelae, especially acute rheumatic fever/rheumatic heart disease continue to occur in significant proportions in many parts of the world. Despite several attempts with various intervention strategies, little success has been achieved in the control of acute rheumatic fever/rheumatic heart disease in India. The success of the control programmes depends upon timely primary prophylaxis with benzathine penicillin for which a microbiological confirmation of group A streptococcal pharyngitis is essential. Isolation of beta hemolytic streptococci from throat cultures and their identification as GAS in the laboratory, clinches the microbiological diagnosis while demonstration of a 'significant rise' in antibody titers such as Anti-streptolysin O and Anti-deoxyribonuclease B differentiates it from a group A streptococcal carrier state or pharyngitis of a viral etiology. Despite the easiness with which these can be achieved, many laboratories in India are not equipped to do so. Enhancing bacteriological and serological facilities in laboratories across the country will drastically improve the clinician's ability to diagnose bonafide GAS pharyngitis and help to institute penicillin prophylaxis at the appropriate time. This will go a long way in enhancing the compliance to penicillin prophylaxis which is the cornerstone of any RF/RHD control program.
  7 11,014 684
CASE REPORTS
Liver abscess caused by Edwardsiella tarda biogroup 1 and identification of its epidemiological triad by ribotyping
V Manchanda, NP Singh, HK Eideh, A Shamweel, SS Thukral
April-June 2006, 24(2):135-137
DOI:10.4103/0255-0857.25205  PMID:16687868
Two clinical isolates and an environmental isolate of Edwardsiella tarda biogroup 1 (ETB1), recovered from liver pus, the stool specimen and from the pond water of the village of the patient, diagnosed to have liver abscess, were found to be identical by protein fingerprinting and ribotyping. It can be construed that the pond water served as the source of infection. The epidemiological triad of the agent (ETB1), host (the patient) and environment (pond water) was thus established. This is the first report in which the triad for extraintestinal Edwardsiellosis caused by ETB1 has been identified. This also constitutes the first report of typing of ETB1 strains by SDS-PAGE and ribotyping.
  7 5,112 212
BRIEF COMMUNICATIONS
Isolation of mycobacteria by Bactec 460 TB system from clinical specimens
V Lakshmi, MA Patil, K Subhadha, V Himabindu
April-June 2006, 24(2):124-126
DOI:10.4103/0255-0857.25197  PMID:16687864
This article reports our experience with the BACTEC 460 TB system in the past five years and its performance characteristics and its advantages over the conventional LJ medium for mycobacterial culture. Clinical specimens (3597) from patients suspected to have tuberculosis were submitted for mycobacterial culture between May 2000 and August 2005 and were processed using the BACTEC 460 TB system. Pulmonary samples were 1568 while the extra pulmonary samples were 2029. BACTEC achieved detection of 681 (18.93%) M. tuberculosis cases (499- pulmonary, 182- extrapulmonary) with a recovery time shorter by 13.2 days compared to conventional method, while 577 (84.7%) were non-tuberculosis mycobacteria. Automated systems can have a great impact and thrust on an early diagnosis of tuberculosis allowing an early and appropriate management of the patient and thereby a better disease outcome.
  6 6,317 305
ORIGINAL ARTICLE
Bacteriological analysis of water samples from Tsunami hit coastal areas of Kanyakumari District, Tamil Nadu
P Rajendran, S Murugan, S Raju, T Sundararaj, BM Kanthesh, EV Reddy
April-June 2006, 24(2):114-116
DOI:10.4103/0255-0857.25188  PMID:16687861
Water borne diseases such as cholera, enteric fever and dysentery were expected after the tsunami, which hit the coastal areas of Kanyakumari district, Tamil Nadu. In the present study 151 drinking water sources were collected from the tsunami affected villages and relief shelters and tested for coliforms and pathogens. Nine well water samples were also collected for specific bacteriological analysis. Presence of coliforms was detected in 56 (37%) water samples. One isolate each of Salmonella Paratyphi B and NAG Vibrio were isolated from two well water samples. There was no report of acute diarroeal diseases or typhoid illness during the post tsunami period monitored by a field microbiology laboratory for a month.
  4 8,447 384
CASE REPORTS
Sino-orbital Aspergillosis in a diabetic patient
DM Sharada, G Arunkumar, KE Vandana, PS Rao
April-June 2006, 24(2):138-140
DOI:10.4103/0255-0857.25207  PMID:16687869
Sino-orbital aspergillosis in a 61-year-old male with uncontrolled non-insulin dependent diabetes mellitus presented with three months history of left ear pain, left side headache with mucopurulent nasal discharge and one week history of progressive swelling and pain with difficulty in opening of the left eye and sudden loss of vision. In spite of surgical debridement and medical management with amphotericin B and itraconazole his visual outcome was poor and the infection was unabated at one month follow up.
  4 4,454 223
Disseminated cryptococcosis in a patient with Nephrotic syndrome
F Qadir, K Manzoor, E Ahmed
April-June 2006, 24(2):141-143
DOI:10.4103/0255-0857.25209  PMID:16687870
Disseminated cryptococcosis mainly occurs in patients with impaired cell mediated immunity. We present a case of disseminated cryptococcosis in a non-HIV patient with nephrotic syndrome who never received immunosuppression. Cultures of bone marrow aspirate, cerebrospinal fluid analysis and histology of skin lesions were all consistent with Cryptococcus neoformans infection. Treatment with amphotericin B followed by fluconazole was successful and in the course of two months when, the skin nodules disappeared.
  3 4,558 205
Role of CSF serology in follow-up of subacute Sclerosing Panencephalitis patients on treatment
E Gupta, L Dar, S Singh, M Behari, S Broor
April-June 2006, 24(2):131-132
DOI:10.4103/0255-0857.25202  PMID:16687866
Subacute sclerosing panencephalitis (SSPE) is a progressive inflammatory disease of the central nervous system with poor prognosis and high mortality. No effective treatment has a proven role; oral isoprinosine and intrathecal administration of a-interferon may prolong survival. We report an unusual case of adult onset SSPE patient on treatment with significant clinical improvement, even in the absence of conversion to seronegativity in either CSF or serum, on follow-up serological examination.
  3 4,433 264
ORIGINAL ARTICLE
Chlamydia trachomatis antigen detection in pregnancy and its verification by antibody blocking assay
R Malenie, PJ Joshi, MD Mathur
April-June 2006, 24(2):97-100
DOI:10.4103/0255-0857.25179  PMID:16687858
Purpose: To detect the prevalence of genital infection caused by Chlamydia trachomatis in pregnant women and also to confirm the positive results using blocking antibody assay. Methods: Endocervical specimens were collected from 200 symptomatic and asymptomatic pregnant women attending the ANC OPD at M P Shah Medical College, Jamnagar. The samples were tested for presence of Chlamydia trachomatis antigen using the monoclonal antibody. Blocking antibody assay was used to further verify the positive results. Results: Out of 200 pregnant women, 38 (19%) were found positive for Chlamydia trachomatis antigen. Out of the 68 symptomatic patients, C. trachomatis antigen was detected in 26.4%. After verification of the positive samples 13.6% of the asymptomatic pregnant women were found to be harbouring the infection in their genital tract. Two (5.2%) out of the 38 positive samples, on verification with the blocking antibody assay, were found to be false positive by IDEIA,TM thus the specificity of the IDEIATM being 94.8%. In patients with previous history of abortions, 27.7% were tested positive for C. trachomatis infection. Conclusions: Significant number of pregnant women shad C. trachomatis antigen in their endocervical canal, which can be easily diagnosed by this simple enzyme immuno assay having a specificity of 94.8%. Verification of positive results by antibody blocking assay can further improve the specificity of this non-culture test. Asymptomatic patients should also be screened for the infection. History of previous abortions places the patient at a higher risk for C. trachomatis infection thus such patients should be definitely tested for chlamydia infection.
  3 12,504 336
CORRESPONDENCE
Seroprevalence of Hepatitis B, Hepatitis C and Human immunodeficiency viruses amongst drug users in Amritsar
R Tiwari, A Aggarwal, P Devi
April-June 2006, 24(2):151-152
DOI:10.4103/0255-0857.25223  PMID:16687877
  3 3,526 194
BRIEF COMMUNICATIONS
Evaluation of simplified dna extraction methods for EMM typing of group a streptococci
JJM Jose, KN Brahmadathan
April-June 2006, 24(2):127-130
DOI:10.4103/0255-0857.25200  PMID:16687865
Simplified methods of DNA extraction for amplification and sequencing for emm typing of group A streptococci (GAS) can save valuable time and cost in resource crunch situations. To evaluate this, we compared two methods of DNA extraction directly from colonies with the standard CDC cell lysate method for emm typing of 50 GAS strains isolated from children with pharyngitis and impetigo. For this, GAS colonies were transferred into two sets of PCR tubes. One set was preheated at 94oC for two minutes in the thermal cycler and cooled while the other set was frozen overnight at -20oC and then thawed before adding the PCR mix. For the cell lysate method, cells were treated with mutanolysin and hyaluronidase before heating at 100oC for 10 minutes and cooling immediately as recommended in the CDC method. All 50 strains could be typed by sequencing the hyper variable region of the emm gene after amplification. The quality of sequences and the emm types identified were also identical. Our study shows that the two simplified DNA extraction methods directly from colonies can conveniently be used for typing a large number of GAS strains easily in relatively short time.
  2 5,280 245
CASE REPORTS
Cyclosporiasis in an infant
RN Iyer
April-June 2006, 24(2):144-145
DOI:10.4103/0255-0857.25210  PMID:16687871
This report describes cyclosporiasis in a seven month old infant who presented with incessant crying and refusal of feeds. The routine modified ZN stained smears showed the oocysts of Cyclospora when all other tests failed to reveal enteric pathogens. The need for the clinical laboratory to screen faeces samples for all possible pathogens in a given clinical situation needs to be emphasized.
  2 3,919 150
CORRESPONDENCE
Perinatal transmission rate of HIV infection in Amritsar (Punjab)
N Jindal, A Aggarwal
April-June 2006, 24(2):146-147
DOI:10.4103/0255-0857.25213  PMID:16687872
  2 2,970 132
cMLS and M Phenotypes among Streptococcus pyogenes isolates in Chennai
SE Jacob, CAC Lloyd, T Menon
April-June 2006, 24(2):147-148
DOI:10.4103/0255-0857.25216  PMID:16687873
  2 3,198 155
BRIEF COMMUNICATIONS
Cytokine measurement in lymphocyte culture supernatant of inactive lepromatous leprosy patients
I Fulya, O Mehmet, A Handan, B Vedat
April-June 2006, 24(2):121-123
DOI:10.4103/0255-0857.25195  PMID:16687863
The aim of the present study was to determine the effects of stimulation of sonicated Mycobacterium leprae (MLS) extract and phorbol myristate acetate (PMA) on the pattern of cytokine production in peripheral blood mononuclear cells (PBMC) and to find out whether there is any difference between stimulation of MLS extract and PMA. Blood samples were collected and PBMC isolated from 43 inactive lepromatous leprosy patients. After culture for 24 hours, lymphocytes were stimulated with MLS extract and PMA. In the culture supernatant, IL-2, 4, 6, 8, TNF-alpha and TGF-beta levels were measured by using ELISA. M. leprae stimulated group IL-6, IL-8, TNF-alpha, TGF-beta levels were found significantly higher than PMA stimulated group ( P <0.05). However, there was no difference between the two groups for IL-4. Only IL-2 levels were higher in PMA stimulated group than M. leprae stimulated group. Sonicated M. leprae extract have a strong effect on cytokine levels in vitro . Our results suggest that antigens with varying specificities favour the production of distinct cytokine patterns following in vitro restimulation.
  1 6,219 277
CASE REPORTS
Larva currens in a case of Organophosphorous poisoning
DS Rao, VRS Rao
April-June 2006, 24(2):133-134
DOI:10.4103/0255-0857.25203  PMID:16687867
A 20-year-old healthy farmer consumed organophosphorous poison. On third day he developed diarrhoea and on fourth day linear serpiginous ulcers appeared on both buttocks. Clinically lesions were considered as decubitus ulcers. By stool examination and other laboratory investigations it was diagnosed as cutaneous larva currens due to S trongyloides stercoralis in a case of organophosphorus poisoning. Patient responded very well to a course of albendazole.
  - 6,037 178
CORRESPONDENCE
Efficacy of chloroquine chemoprophylaxis for Plasmodium falciparum in Dindori District, Madhya Pradesh
PK Bharti, AC Nagpal, N Singh
April-June 2006, 24(2):148-149
DOI:10.4103/0255-0857.25218  PMID:16687874
  - 2,998 120
Detection of Pneumocystis carinii in Induced sputum samples of HIV positive patients
M Mishra, YS Thakar, SL Akulwar, NS Tankhiwale, RM Powar
April-June 2006, 24(2):149-150
DOI:10.4103/0255-0857.25221  PMID:16687875
  - 3,817 288
Antibacterial activity of glass-ionomer restorative cements and polyacid modified composite resin against Cariogenic bacteria
T Menon, CPG Kumar, K Dinesh
April-June 2006, 24(2):150-151
DOI:10.4103/0255-0857.25222  PMID:16687876
  - 4,341 358
BOOK REVIEW
Practical manual of medical virology
V Ravi
April-June 2006, 24(2):154-154
  - 3,764 260

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