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GUEST EDITORIAL |
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Development of antibiotic resistance and its audit in our country: How to develop an antibiotic policy |
p. 381 |
Chand Wattal DOI:10.4103/0255-0857.103755 PMID:23183459 |
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REVIEW ARTICLE |
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Emergence and dissemination of antibiotic resistance: A global problem  |
p. 384 |
R Choudhury, S Panda, DV Singh PMID:23183460Antibiotic resistance is a major problem in clinical health settings. Interestingly the origin of many of antibiotic resistance mechanisms can be traced back to non-pathogenic environmental organisms. Important factors leading to the emergence and spread of antibiotic resistance include absence of regulation in the use of antibiotics, improper waste disposal and associated transmission of antibiotic resistance genes in the community through commensals. In this review, we discussed the impact of globalisation on the transmission of antibiotic resistance genes in bacteria through immigration and export/import of foodstuff. The significance of surveillance to define appropriate use of antibiotics in the clinic has been included as an important preventive measure. |
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ORIGINAL ARTICLES |
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Development and evaluation of reverse-transcription loop-mediated isothermal amplification for rapid detection of human immunodeficiency virus type 1 |
p. 391 |
Xihong ZHAO, Xiaoping CHEN, Youhong ZHANG, Xiaowei HE, Wenmei LI, Lei SHI, Xingzhou CHEN, Zhenbo XU, Nanjing ZHONG, Guiyuan JI, Liansheng YANG, Jihua WANG DOI:10.4103/0255-0857.103757 PMID:23183461Purpose: The objective of this study was to establish a reverse-transcription loop-mediated isothermal amplification (RT-LAMP) method for rapid detection of human immunodeficiency virus type 1 (HIV-1). Materials and Methods: The HIV-1 integrase gene region was selected because it was a conserved part of the HIV-1 genome. Six primers specific to eight regions of the HIV-1 integrase gene were designed. A total of 171 samples (18 HIV-1 confirmed positive samples and 153 serum specimens were collected in this study) were tested by RT-LAMP and reverse-transcription polymerase chain reaction (RT-PCR). After amplification in an isothermal water bath for 45 min, samples containing HIV-1 generated the expected ladder-like products while other viruses generated no product. Results: The sensitivity and specificity of the RT-LAMP assay were evaluated by comparison with RT-PCR. The assay was significantly more sensitive than normal gel-based RT-PCR. Conclusion: Because it is specific and simple, the RT-LAMP assay can be widely applied in clinical laboratories for rapid detection of HIV-1. |
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Evaluation of two indigenous rapid and two ELISA assays for the diagnosis of HIV infection India  |
p. 397 |
HS Iqbal, S Solomon, KG Murugavel, SS Solomon, P Balakrishnan DOI:10.4103/0255-0857.103758 PMID:23183462Purpose: Human immunodeficiency virus (HIV) diagnostic tests are being used extensively in India. However, the evaluation data on these assays are very limited. The present study evaluates indigenous HIV test kits manufactured in India. Materials and Methods: A total of 200 characterised specimens were assayed with Comb AIDS - RS Advantage HIV 1+2 Immunodot Test, Enzaids HIV 1+2 ELISA test, Enzaids Duet HIV Antigen+antibody ELISA test and Signal HIV Flow Through HIV 1+2 test kits. Performance characteristics of these assays were calculated. Results: Sensitivity, specificity, positive predictive value, negative predictive value and efficiency of all the assays were 100% except for Signal HIV Flow Through HIV 1+2 test kit. The specificity, positive predictive value and efficiency of the Signal HIV Flow Through HIV 1+2 test kit were 98.9%, 98.9% and 99.4%, respectively. The Enzaids Duet HIV kit was found to be extremely sensitive in detecting p24 Ag with the sensitivity of 1.5 pg/mL. Conclusions: To conclude, selection of better diagnostic assay is very much important to resolve discrepancies in HIV diagnosis. All these assays under evaluation in this report have got excellent performance characteristics and much suitable to use in serial testing algorithms in use for resources limited settings. |
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Comparison of HIV-1 RNA level estimated with plasma and DBS samples: A pilot study from India (South) |
p. 403 |
S David, J Sachithanandham, J Jerobin, S Parasuram, R Kannangai DOI:10.4103/0255-0857.103759 PMID:23183463Purpose: The use of dried blood spots (DBS) for HIV-1 viral load determination could greatly enhance the management of HIV infected individuals in resource-limited countries. Objective: To compare the HIV-1 viral load values obtained between parallel collected plasma and DBS. Materials and Methods: DBS and plasma samples were collected from 62 HIV-1 infected individuals and were used for determination of HIV-1 RNA concentrations using the Abbot real-time HIV-1 PCR. Result: Mean of the log difference of viral load values between plasma and DBS was -0.41 log. DBS viral load values significantly correlated with plasma viral load (r = 0.9818, P < 0.0001). Conclusion: These results suggest that DBS samples can be used as an alternative to plasma for the estimation of HIV-1 viral load if samples are appropriately stored. |
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Detection of human parvovirus B19 in cancer patients using ELISA and real-time PCR |
p. 407 |
SA Zaki DOI:10.4103/0255-0857.103760 PMID:23183464Purpose: Parvovirus B19 (B19) is associated with a wide range of diseases in humans, whose severity depends on the immunological and haematological status of the host. Objective: To determine the incidence of B19 DNA and specific IgM and IgG frequency among patients suffering from different haematological malignancies and to determine the viral load using real-time PCR. Materials and Methods: A total of 70 patients were included in the study, in addition to a control group consisting of 20 apparently healthy volunteers. B19 DNA quantitative analysis was performed using real-time PCR while screening for IgM and IgG anti-B19 antibodies was performed using ELISA. Results: B19 DNA was detected in 26 patients (36.14%) and 3 controls (15%) using real-time PCR. Anti-parvovirus B19 IgM antibodies were detected in 9 patients (12.6%) and 2 controls (10%). Anti-parvovirus B19 IgG antibodies were detected in 32 patients (45.71%) and 5 controls (25%). The difference between the patient and control groups was found to be statistically non-significant in all of the three tests (P < 0.05). The difference in B19 incidence among patients receiving multiple transfusions and non-transfused patients was also found to be statistically non-significant (P < 0.05). Conclusion: We found a high incidence of B19 infection among patients diagnosed with different types of haematological malignancies. We recommend that all cases of haematological disorders should be examined for specific antibodies and tested for the presence of B19 DNA in serum by PCR technique. |
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Phenotypic and genotypic characteristics of drug resistance in Mycobacterium tuberculosis isolates from pediatric population of Chennai, India |
p. 411 |
K Lily Therese, R Gayathri, S Balasubramanian, S Natrajan, HN Madhavan DOI:10.4103/0255-0857.103761 PMID:23183465Purpose: Multidrug-resistant TB (MDR-TB) has been reported in almost all parts of the world. Childhood TB is accorded low priority by national TB control programs. Probable reasons include diagnostic difficulties, limited resources, misplaced faith in BCG and lack of data on treatment. Good data on the burden of all forms of TB among children in India are not available. Objective: To study the drug sensitivity pattern of tuberculosis in children aged from 3 months to 18 years and the outcome of drug-resistant tuberculosis by BACTEC culture system and PCR-based DNA sequencing technique. Materials and Methods: This is a retrospective study. One hundred and fifty-nine clinical specimens were processed for Ziehl-Neelsen stain, Mycobacterial culture by BACTEC method, phenotypic DST for first-line drugs for Mycobacterium tuberculosis (M. tuberculosis) isolates and PCR-based DNA sequencing was performed for the M. tuberculosis isolates targeting rpoB, katG, inhA, oxyR-ahpC, rpsL, rrs and pncA. Results and Conclusion: Out of the 159 Mycobacterial cultures performed during the study period, 17 clinical specimens (10.7%) were culture positive for M. tuberculosis. Among the 17 M. tuberculosis isolates, 2 were multidrug-resistant TB. PCR-based DNA sequencing revealed the presence of many novel mutations targeting katG, inhA, oxyR-ahpC and pncA and the most commonly reported mutation Ser531Leu in the rpoB gene. This study underlines the urgent need to take efforts to develop methods for rapid detection and drug susceptibility of tubercle bacilli in the pediatric population. |
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Efficiency of two commercial kits in serodiagnosis of leptospiral uveitis |
p. 418 |
A Kannan, CG Priya, L Prajna, SR Rathinam DOI:10.4103/0255-0857.103762 PMID:23183466Purpose: Uveitis is an important complication of systemic leptospirosis that can occur months to years after systemic infection. The gold standard technique Microscopic Agglutination Test (MAT) is less sensitive and more complicated. All the commercial kits currently available are for early detection of acute systemic leptospiral infection. The purpose of this study is to evaluate the efficiency of two commercial kits in serodiagnosis of leptospiral uveitis, which is a late manifestation. Materials and Methods: Serum samples from leptospiral uveitis patients 20 MAT positive, 20 MAT negative, 15 non-leptospiral uveitis patients, 20 systemic leptospiral infected patients and 21 controls were selected. These samples were tested for the presence of leptospiral IgM antibodies by (i) MAT using a panel of 20 serovars, (ii) LEPTO IgM MICROLISA (J.Mitra & Co.Pvt. Ltd, India) and (iii) Leptocheck (Zephyr Biomedicals, India). The statistical analysis was carried out using stata 11.0. Results: Total of 96 samples were tested with two commercial kits, Lepto IgM MICROLISA and Leptocheck. The sensitivity and specificity of Lepto IgM MICROLISA was 60% and 55% and Leptocheck was 80% and 59% respectively in comparison to MAT. In comparison to clinical diagnosis the sensitivity of IgM Microlisa was 55%, Leptocheck 70% and specificity of IgM MICROLISA was 58.33% and leptocheck was 69.44%. Conclusion: Commercial kits though sensitive and specific for systemic leptospirosis, have limited diagnostic capacity for leptospiral uveitis. Therefore it is essential to develop an inhouse serodiagnostic method specific for leptospiral uveitis patients using local leptospiral isolates. |
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Salmonella enterica serovar Typhi plasmid pR ST98 -mediated inhibition of autophagy promotes bacterial survival in infected fibroblasts |
p. 423 |
J Lv, S Wu, L Wei, Y Li, P He, R Huang DOI:10.4103/0255-0857.103763 PMID:23183467pR ST98 is a chimeric plasmid isolated from Salmonella enterica serovar typhi (S. typhi) and mediates both drug-resistance and virulence of S. typhi. Autophagy has been recently reported as an important component of the innate immune response against intracellular pathogen. In this study, we investigated the effect of pR ST98 on cellular autophagy, apoptosis and bacterial survival in infected fibroblasts. S. typhi strain ST 8 carrying pR ST98 , Salmonella typhimurium strain SR-11 carrying a 100 Kb virulent plasmid, and avirulent S. typhi strain ST 10 without plasmid were tested in this experiment. Results showed that embryonic fibroblasts infected with ST 8 containing pR ST98 had decreased autophagy accompanied by increased bacterial survival and apoptosis. Further study showed that autophagy inducer rapamycin reversed pR ST98 -mediated inhibition of autophagy and reduced apoptosis in infected fibroblasts. Our data indicate that pR ST98 can inhibit autophagy, thus facilitating S. typhi survival and promoting apoptosis of host cells. This study contributes to understanding the underlying mechanism of pR ST98 -mediated virulence in S. typhi. |
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Effect of biotherapeutics on antitoxin IgG in experimentally induced Clostridium difficile infection |
p. 431 |
S Kaur, C Vaishnavi, R Kochhar, KK Prasad, P Ray DOI:10.4103/0255-0857.103764 PMID:23183468Purpose: Recurrent diarrhoea after successful treatment of primary Clostridium difficile associated disease (CDAD) occurs due to bowel flora alterations and failure to mount an effective antibody response. Apart from antibiotics, risk factors include immunosuppressive and acid-suppressive drug administration. Biotherapeutics such as probiotic and epidermal growth factor (EGF) may offer potential effective therapy for CDAD. Materials and Methods: The effect of biotherapeutics in mounting an antibody response against C. difficile toxins was studied in BALB/c mice challenged with C. difficile after pre-treatment with ampicillin, lansoprazole or cyclosporin. Sera from sacrificed animals were estimated for antitoxin IgG by enzyme linked immunosorbent assay. Results: Antitoxin IgG was significantly higher (P<0.05) in C. difficile challenged groups compared to unchallenged controls, but insignificant (P>0.05) in animals in which C. difficile was given after pre-treatment with cyclosporin compared to those without any pre-treatment, or pre-treatment with antibiotic or lansoprazole. In inter-subgroup comparisons also significant anomaly in production of antitoxin IgG was found. The antitoxin IgG levels were raised in animals administered C. difficile after pre-treatment with ampicillin, but lower in animals administered cyclosporin. High levels of antitoxin IgG were also found in the serum samples of animals receiving lansoprazole and C. difficile. Conclusions: Probiotics showed their beneficial effect by boosting the immune response as seen by production of antitoxin IgG. Oral administration of EGF did not affect the immune response to C. difficile toxins as significant increase was not observed in the serum antitoxin IgG levels in any of the groups investigated. |
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First characterisation of plasmid-mediated quinolone resistance-qnrS1 co-expressed bla CTX-M-15 and bla DHA-1 genes in clinical strain of Morganella morganii recovered from a Tunisian Intensive Care Unit |
p. 437 |
S Mahrouki, A Bourouis, H Chihi, R Ouertani, M Ferjani, MB Moussa, F Barguellil, O Belhadj DOI:10.4103/0255-0857.103765 PMID:23183469Purpose: Aim of this study was to show the emergence of the qnr genes among fluoroquinolone-resistant, AMPC and ESBL (extended-spectrum-beta-lactamase) co-producing Morganella morganii isolate. Materials and Methods: A multi resistant Morganella morganii SM12012 isolate was recovered from pus from a patient hospitalized in the intensive care unit at the Military hospital, Tunisia. Antibiotic susceptibility was tested with the agar disk diffusion method according to Clinical and Laboratory Standards Institute guidelines. ESBLs were detected using a standard double-disk synergy test. The characterization of beta-lactamases and associated resistance genes were performed by isoelectric focusing, polymerase chain reaction and nucleotide sequencing. Results: The antimicrobial susceptibility testing showed the high resistance to penicillins, cephalosporins (MICs: 64-512 μg/ml) and fluoroquinolones (MICs: 32-512 μg/ml). But M. morganii SM12012 isolate remained susceptible to carbapenems (MICs: 4-<0.25 μg/ml). The double-disk synergy test confirmed the phenotype of extended-spectrum β-lactamases (ESBLs). Three identical β-lactamases with pI values of 6.5, 7.8 and superior to 8.6 were detected after isoelectric focusing analysis. These β-lactamases genes can be successfully transferred by the conjugative plasmid. Molecular analysis demonstrated the co-production of bla DHA-1, bla CTX-M-15 and qnrS1 genes on the same plasmid. The detection of an associated chromosomal quinolone resistance revealed the presence of a parC mutation at codon 80 (Ser80-lle80). Conclusion: This is the first report in Tunisia of nosocomial infection due to the production of CTX-M-15 and DHA-1 β-lactamases in M. morganii isolate with the association of quinolone plasmid resistance. The incidence of these strains invites continuous monitoring of such multidrug-resistant strains and the further study of their epidemiologic evolution. |
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Plasmid mediated quinolone resistance determinants qnr, aac(6′)-Ib-cr, and qep in ESBL-producing Escherichia coli clinical isolates from Egypt |
p. 442 |
WM Hassan, A Hashim, RAA Domany DOI:10.4103/0255-0857.103766 PMID:23183470Purpose: To characterize the prevalence of plasmid-mediated quinolone resistance determinants qnr, aac(6′)-Ib-cr and qep in extended-spectrum β-lactamase (ESBL) -producing E. coli and to determine the association of these determinants with CTX-M group in Cairo, Egypt. Materials and Methods: MICs of 15 antimicrobial agents against 70 E. coli clinical isolates were determined using agar dilution technique according to CLSI. Screening for the qnrA, qnrB, qnrS, aac(6′)-Ib, qep and CTX-M genes was carried out by PCR amplification and DNA sequencing. Curing was used to confirm whether qnr, aac(6′)-Ib, qep or ESBL-encoding genes were located on plasmids. Results: Out of 70 E. coli clinical isolates, 61 were resistant to at least one antibiotic, 16 (22.8%) were multidrug resistant and 30 (42%) were ESBL producers. Out of 30 ESBL producers E. coli isolates, 8 (26.6%) were positive for qnr genes, and the qnrA1-, qnrB1-and qnrS1-type genes were detected alone or in combination in 5 (16.6%), 7 (23.3%) and 5 (16.6%) isolates, respectively. Seven (23.3%) isolates were positive for aac(6′)-Ib-cr and only two (6.6%) isolates were positive for qepA4. Loss of all plasmids upon curing suggested that qnr, aac(6′)-Ib-cr , qep A4 and ESBL-encoding genes were always plasmid mediated. Out of 8 Qnr positive isolates 5 were associated with both CTX-M-1 and CTX-M-9 while 2 from 6 aac(6′)-Ib-cr positive isolates were associated with both CTX-M-1 and CTX-M-9. Conclusions: This study highlights the prevalence of quinolone resistance determinants qnr, aac(6′)-Ib-cr , qep A4 associated with CTX-M positive E. coli isolates from Egypt. This is the first report of the plasmid mediated fluoroquinolone efflux pump, Qep A from Egypt. |
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Colistin against colistin-only-susceptible Acinetobacter baumannii-related infections: Monotherapy or combination therapy? |
p. 448 |
F Simsek, H Gedik, MT Yildirmak, NE Iris, A Türkmen, A Ersoy, M Ersöz, A Gücüyener DOI:10.4103/0255-0857.103767 PMID:23183471Purpose: To evaluate the outcomes of the patients who were infected with colistin-only-susceptible (COS) Acinetobacter baumannii and treated with either colistin monotherapy or colistin combined therapy. Materials and Methods: This retrospective case-control study was conducted in the training and research hospital with an 800 beds between August 2008 and December 2011. The patients, who were infected with COS A. baumannii and received either colistin monotherapy or colistin combined therapy, were included into the study. Results: In total, 51 patients fulfilling study criteria were evaluated. Colistin monotherapy was found effective as much as colistin combined therapy in terms of clinical and microbiological responses in patients with ventilator associated pneumonia (VAP) and also in patients with blood stream infections. Conclusion: Although there is no randomised controlled study yet, colistin monotherapy and colistin combined therapy are likely to achieve similar treatment responses rates. Heteroresistant strains can emerge in patients who receive colistin monotherapy |
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Differences in vancomycin MIC among MRSA isolates by agar dilution and E test method |
p. 453 |
K Tandel, AK Praharaj, S Kumar DOI:10.4103/0255-0857.103768 PMID:23183472In this study, the correlation between vancomycin minimum inhibitory concentration (MIC) obtained by the E test technique and the Clinical And Laboratory Standards Institute (CLSI) agar dilution method was evaluated. A total of 53 Methicillin Resistant Staphylococcus aureus (MRSA) strains were tested by both the methods in the present study. MICs of vancomycin obtained by the E test method were consistently higher (+0.5 to 2 log2 dilutions) than those obtained by the agar dilution method. Out of 53 MRSA isolates, 49 isolates showed higher MIC results by E test than by agar dilution method. Three isolates showed same MIC result by both methods. Since many studies have demonstrated increased clinical failure with MRSA isolates for which vancomycin MICs are increased (>1 μg/ml) but still within the susceptibility range (≤ 2 μg/ml), our findings suggest the requirement to re-look into the breakpoints for vancomycin for determining sensitivity of MRSA isolates. Guidelines should also specify the method to be used for determining the MIC. |
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Detection of metallo-β-lactamases producing Acinetobacter baumannii using microbiological assay, disc synergy test and PCR |
p. 456 |
M Purohit, DK Mendiratta, VS Deotale, M Madhan, A Manoharan, P Narang DOI:10.4103/0255-0857.103770 PMID:23183473Background: One leading factor responsible for resistance in Acinetobacter baumannii, an important opportunist in health care institutions globally, is the production of carbapenamases like metallo-β-lactamases (MBLs), which hydrolyze a variety of β-lactams including penicillin, cephalosporins and carbapenems. However, neither any standard guidelines are available nor any method has been found to be perfect for their detection. Various methods have shown discordant results, depending upon the employed methodology, β-lactamase substrate and MBL inhibitor used. This study aims to evaluate two phenotypic methods against PCR as gold standard among carbapenem resistant A. baumannii for identifying MBL producers. Materials and Methods: A total of 130 A. baumannii were screened for imipenem and meropenem resistance by Kirby-Bauer disc diffusion method. Phenotypic expression of MBL was detected by EDTA-imipenem-microbiological (EIM) assay and extended EDTA disc synergy (eEDS) test and presence of bla-IMP and bla-VIM was detected by PCR in all the carbapenem resistant isolates. Results: Of the 43 imipenem and/or meropenem resistant A. baumannii isolates, 4 (9.3%) were found to be MBL producers by EIM and 3 (6.97%) by eEDS. Only bla-VIM gene was detected in 7 (16.28%) by PCR. In addition EIM detected 14 (32.56%) carbapenem resistant non-metallo enzyme producers. Conclusion: Of the two MBL genes targeted, bla-VIM was only detected and that too in isolates resistant to both imipenem and meropenem. Further, EIM was useful in differentiating MBL from non-metalloenzymes producers. |
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BRIEF COMMUNICATIONS |
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16S rDNA-based metagenomic analysis of human oral plaque microbiota in patients with atherosclerosis and healthy controls |
p. 462 |
F Ismail, C Baetzner, W Heuer, N Stumpp, J Eberhard, A Winkel, I Ismail, A Haverich, M Stiesch DOI:10.4103/0255-0857.103771 PMID:23183474To address the question if an altered oral microbiota is associated with atherosclerosis. Twenty patients suffering from atherosclerosis and 10 controls were recruited. Clinical oral, medical and laboratory investigations were performed. Oral bacteria were collected and 16S rDNA was sequenced following Single strand conformation polymorphism.(SSCP) Probing pocket depths in patients were significantly elevated. The oral microbiota of patients and controls were dominated by Fusobacterium (16%/17%), Streptococcus (21%/14%), Prevotella (10%/12%), Enterococcus (12%/12%), Porphyromonas (8%/7%), TM7 (0%/7%) and Veillonella (6%/7%). Differences in diversity were not significant between groups.
The pathology of atherosclerosis may not be related to significant qualitative changes of the oral microbiota. |
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Markers of pathogenicity islands in strains of Aeromonas species of clinical and environmental origin |
p. 467 |
JM Ruiz-Ruiz, MG Aguilera-Arreola, G Castro-Escarpulli DOI:10.4103/0255-0857.103772 PMID:23183475The aim of this study was to investigate the presence of markers of pathogenicity islands that may be informative to detect the virulent PAI carriers of clinical and environmental strains of Aeromonas spp. isolated in Mexico. virB2, virB9 and virB11 genes were found in Aeromonas strains isolated from environmental and clinical sources while cagE and tfc16 genes were only in strains of environmental origin. Having performed the wide screening presented in this study, we now have a set of strains to map and confirm the presence of a pathogenicity island in Aeromonas strains isolated in Mexico. |
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A pilot study to determine genetic polymorphism in Mycobacterium tuberculosis isolates in Central India |
p. 470 |
P Desikan, DS Chauhan, P Sharma, N Panwalkar, S Gautam, VM Katoch DOI:10.4103/0255-0857.103774 PMID:23183476This study was carried out to identify predominant spoligotypes responsible for transmission and prevalence of tuberculosis in central India since there is no data available about the genetic biodiversity of Mycobacterium tuberculosis isolates from patients with tuberculosis in this region. 35 strains of Mycobacterium tuberculosis were subjected to spoligotyping according to the standard protocol. A total of 25 strains out of the 35 (71.42%) could be grouped in to 6 clusters. The largest cluster comprised 8 isolates. Unique (Non-clustered) spoligotypes were seen in 10 isolates, Nine strains did not match the data base (Spol DB-4 data base). The results indicate that there may be a number of orphan strains unique to this geographical area. Further studies on a larger sample size derived from this area would help us delineate the epidemiology of Mycobacterium tuberculosis infection in this area. |
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CASE REPORTS |
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Recurrent meningitis due to Salmonella enteritidis: A case report from Kashmir India |
p. 474 |
BA Fomda, BA Charoo, JA Bhat, N Reyaz, P Maroof, MI Naik DOI:10.4103/0255-0857.103776 PMID:23183477Recurrent bacterial meningitis in children is potentially life-threatening and induces psychological trauma to the patients through repeated hospitalization. Here we report a case of recurrent meningitis in a one month old baby. The CSF and blood culture grew Salmonella enteritidis. Injection ciprofloxacin and ceftriaxone were given for 3 weeks. Baby became symptomatically better and was afebrile at discharge. Twenty eight days after discharge baby got readmitted with complaints of fever and refusal of feeds. Blood and CSF culture again showed growth of Salmonella enteritidis. Physicians should be educated about the possibility of recurrence which may occur days or even weeks after apparent successful antibiotic treatment. |
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Necrotizing fasciitis caused by a variant of epidemic methicillin resistant Staphylococcus aureus -15 |
p. 476 |
S Govindan, B Chakrakodi, S Prabhakara, G Arakere, S Kumar, I Bairy DOI:10.4103/0255-0857.103778 PMID:23183478We report a case of necrotizing fasciitis (NF), caused by community-acquired epidemic methicillin resistant Staphylococcus aureus 15 (EMRSA 15). The patient had a prolonged recovery period following treatment with antibiotics and surgical debridement of the infected part. Molecular characterization revealed that the isolate carried Staphylococcal Cassette Chromosome mec (SCC mec) type IV harboring Panton-Valentine Leucocidin (pvl) gene and having accessory gene regulator (agr) type I. The isolate was positive for enterotoxin gene cluster (egc). Pulsed field gel electrophoresis patterns revealed that the isolate belonged sequence type 22, which is an Indian variant of EMRSA 15, reported earlier. |
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Intramedullary hydatid cyst of the cervical spine |
p. 480 |
Senol , Mehmet Güney, Tekeli , Hakan Kendirli, Mustafa Tansel, Kaya , Serdar , Turhan Vedat, Sonmez Güner, Saracoglu , Meh DOI:10.4103/0255-0857.103780 PMID:23183479Hydatid disease (Echinococcosis) is a common parasitic infection caused by Echinococcus granulosus mainly in sheep-raising areas of the world. Liver, lungs and brain are the predominantly involved organs. However, 0.5-1% of the hydatid disease involves the spine and in 90% of the cases it is confined to the bone and the epidural space. Although intramedullary involvement is extremely rare, in this report, we present a 55-year-old female patient who was diagnosed with a cervical intramedullary hydatid cyst during magnetic resonance imaging of the cervical vertebrae. Accordingly, we imply that particularly in endemic areas, hydatid cyst disease should be kept in mind for the differential diagnosis of spinal mass lesions. |
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CORRESPONDENCE |
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A few remarks on isolation, speciation and antibiogram of clinically relevant nondiphtheroidal corynebacteria (diphtheroids) |
p. 482 |
Rupali Dey, Kalidas Rit, Bipasa Chakraborty, Prasanta K Maiti DOI:10.4103/0255-0857.103781 PMID:23183480 |
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Author's reply |
p. 482 |
Abhijit Chaudhury |
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Comparative in vitro evaluation of activity of tigecycline against susceptible and multidrug resistant organisms |
p. 483 |
V Gupta, N Bansal, J Chander DOI:10.4103/0255-0857.103784 PMID:23183481 |
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Changing susceptibility patterns of nonfermenting Gram-negative bacilli |
p. 485 |
S Arora, V Gautam, P Ray DOI:10.4103/0255-0857.103785 PMID:23183482 |
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An unusual presentation of cutaneous larva migrans in a male child |
p. 486 |
I Mohanty, S Patnaik, P Mohanty DOI:10.4103/0255-0857.103787 PMID:23183483 |
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Umpteen secrets of a hidden life: Plasmodium falciparum gametocytes |
p. 488 |
S Sharma, N Kumar DOI:10.4103/0255-0857.103788 PMID:23183484 |
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Fragment size polymorphism in Plasmodium falciparum histidine rich proteins among Indian population is a cause for concern in rapid diagnosis of malaria |
p. 488 |
N Kumar, S Sharma DOI:10.4103/0255-0857.103790 PMID:23183485 |
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Catheter-related bacteremia due to M. chelonae in an immunocompromised patient: An emerging nosocomial pathogen |
p. 489 |
S Jain, S Singh, MM Sankar, R Saha, RR Rangaraju, TD Chugh DOI:10.4103/0255-0857.103792 PMID:23183486 |
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RESEARCH SNIPPETS |
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Research snippets |
p. 492 |
Prabha Desikan |
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