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  Citation statistics : Table of Contents
   2009| October-December  | Volume 27 | Issue 4  
    Online since September 4, 2009

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Established and potential risk factors for clostridum difficile infection
C Vaishnavi
October-December 2009, 27(4):289-300
DOI:10.4103/0255-0857.55436  PMID:19736396
Clostridium difficile is the aetiological agent for almost all cases of pseudo membranous colitis and 15-25% of antibiotic associated diarrhoea. In recent years, C. difficile associated disease (CDAD) has been increasing in frequency and severity due to the emergence of virulent strains. Severe cases of toxic mega colon may be associated with mortality rates of 24-38%. The prevalence of CDAD is global and the incidence varies considerably from place to place. In the initial stages of its discovery, C. difficile infection was regarded mainly as an outcome of antibiotic intake and not as a life threatening disease. Intervention by man has produced conditions making C. difficile a significant cause of morbidity and mortality. The recent outbreak of CDAD in Quebec has sent the alarm bells ringing. Apart from a threefold increase in the incidence of CDAD, clinicians have also reported a higher number of cases involving toxic mega colon, colectomy or death. Among all the risk factors, inclusive of the host and the environmental factors, antibiotics are the most important ones. Surgical patients comprise 55-75% of all patients with CDAD due to the fact that perioperative prophylaxis requires the use of antibiotics. However, other drugs such as immunosuppressants and proton pump inhibitors are also important risk factors. Thus CDAD is a growing nosocomial and public health challenge. Additionally, the recognition of community acquired CDAD signals the presence of several risk factors. In this review, the established and potential risk factors of CDAD, along with the epidemiology, diagnostic modalities, management and preventive measures of the disease have been elaborated.
  30 12,484 1,415
Review of virulence factors of enterococcus : An emerging nosocomial pathogen
PM Giridhara Upadhyaya, KL Ravikumar, BL Umapathy
October-December 2009, 27(4):301-305
DOI:10.4103/0255-0857.55437  PMID:19736397
Enterococcus, considered a normal commensal of intestinal tract, is fast emerging as a pathogen causing serious and life threatening hospital borne infections. This is attributed to acquisition of multi drug resistance and virulence factors of the organisms. The sequencing of Enterococcus faecalis has given a lot of insight into its genetic makeup. The E. faecalis strain V583, which has been sequenced, contains a total of 3182 open reading frames (ORFs) with 1760 of these showing similarity to known proteins and 221 of unknown functions. Strikingly unique to this genome is the fact that over 25% of the genome is made up of mobile and exogenously acquired DNA which includes a number of conjugative and composite transposons, a pathogenicity island, integrated plasmid genes and phage regions, and a high number of insertion sequence (IS) elements. This review addresses the genomic arrangement and the study of virulence factors that have occurred since the sequencing of the genome.
  26 22,632 1,965
Magnitude of drug resistant shigellosis: A report from Bangalore
H Srinivasa, M Baijayanti, Y Raksha
October-December 2009, 27(4):358-360
DOI:10.4103/0255-0857.55460  PMID:19736408
Shigella is an important cause of acute invasive diarrhea in children and others. Antimicrobial susceptibility of Shigella spp. isolated from diarrhoeal/ dysenteric patients in Bangalore was studied in our hospital from January 2002 to December 2007. One hundred and thirty-four isolates were identified as Shigella species. S. flexneri, S. sonnei , S. boydii and S. dysenteriae were accounted respectively for 64.9%, 21.6%, 8.2% and 3.7% of the total number of Shigella isolated. Of these 56 (41.8%) were from children (0 to 14 years) and 78 (58.2%) were from adults and elderly patients. Over 70% of Shigella isolates were resistant to two or more drugs including Ampicillin and Co-trimoxazole. During 2002 to 2007, resistance to Ampicillin had increased from 46.7% to 68%. For Co-trimoxazole, though the resistance had gradually decreased from 100% to 72%, but still the resistance is high. Chloramphenicol resistance showed sudden decline from 73.3% to 25% from 2002 to 2003, but gradually has reached 48%. Nalidixic acid resistance was more than 70%. All isolates were sensitive to Ciprofloxacin during the period 2002 to 2004, but over the years the resistance pattern gradually increased up to 48%. Ceftriaxone had shown no resistance. The results of the study revealed the endemicity of Shigellosis with S. flexneri as the predominant serogroup. Children were at a higher risk of severe shigellosis. The results also suggest that Ampicillin, Co-trimoxazole, Chloramphenicol, Nalidixic acid and Ciprofloxacin should not be used empirically as the first line drugs in the treatment of Shigellosis. Periodic analysis and reporting of antibiotic susceptibility is an important measure to guide antibiotic treatment.
  24 6,022 512
Primary cutaneous aspergillosis due to Aspergillus niger in an immunocompetent patient
S Mohapatra, I Xess, JV Swetha, N Tanveer, D Asati, M Ramam, MK Singh
October-December 2009, 27(4):367-370
DOI:10.4103/0255-0857.55462  PMID:19736412
Primary cutaneous aspergillosis is a rare entity, usually caused by A. fumigatus and A. flavus . Here, we present such a case, manifested by ulceration due to A. niger, which remained undiagnosed for a prolonged period. The immunological status was intact, although the patient had associated severe fungal infection. Recurrence of the lesion occurred despite repeated anti-fungal therapies. Anti fungal testing was done based on the broth dilution (M-38A, NCCLS, USA) method. The culture isolate was found to be sensitive to fluconazole and amphotericin B. Continuation of antifungal therapy improved the symptoms, reducing the size of the lesion.
  12 7,509 470
Distribution of Malassezia species in patients with pityriasis versicolor in Northern Iran
T Shokohi, P Afshar, A Barzgar
October-December 2009, 27(4):321-324
DOI:10.4103/0255-0857.55445  PMID:19736400
Purpose : Malassezia yeasts are globally distributed agents of pityriasis versicolor and are implicated in the pathogenesis of seborrhoeic and atopic dermatitis. The aim of this study is to identify the Malassezia species obtained from pityriasis versicolor patients, using morphological, biochemical, physiological as well as Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) methods. Materials and Methods: The identification of Malassezia species is performed according to microscopic features and physiological characteristics, including catalase reaction and Tween assimilation tests. The DNA is extracted from cultured Malassezia using the glass bead, phenol-chloroform method. The internal transcribed spacer 1(ITS1) region is amplified and there is restricted digestion of the PCR products with two enzymes Cfo I and Bst F5I. Results : The most commonly isolated species is M. globosa (47.6%). RFLP analysis of the PCR products of the ITS1 region is in complete agreement with those from the DNA sequences of the internal transcribed spacer (ITS) 1 region and the biochemical tests. Conclusion : Based on the findings of this study, it can be concluded that PCR-RFLP is a relatively simple and quick method, completely comparable to the routine methods used for Malassezia identification.
  8 5,124 439
Red grain botryomycosis due to Staphylococcus aureus - A novel case report
V Katkar, F Mohammad, S Raut, R Amir
October-December 2009, 27(4):370-372
DOI:10.4103/0255-0857.55458  PMID:19736413
Staphylococcus aureus and some other bacteria are known to cause botryomycosis. These bacteria are known to produce yellowish-white soft grains. Only Actinomadura pelletieri is known to produce red grains. We report here a case of an intensely inflammatory type of botryomycosis. A 35-year-old male labourer presented with swelling, redness and multiple sinuses on his foot, of eight months duration. The purulent discharge contained bright red coloured grains, 0.5 to 1 mm in size, which were round to oval in shape. Gram-positive cocci were demonstrated in crushed granules and tissue sections. Culture yielded pure and heavy growth of Staphylococcus aureus . He responded very well to cefazolin. There is no other report of such red grain botryomycosis due to Staphylococcus aureus , available in literature. This is first case report of its kind in world literature.
  5 4,174 327
Beijing genotype and other predominant Mycobacterium tuberculosis spoligotypes observed in Mashhad city, Iran
M Rohani, P Farnia, M Naderi Nasab, R Moniri, M Torfeh, MM Amiri
October-December 2009, 27(4):306-310
DOI:10.4103/0255-0857.55441  PMID:19736398
Purpose : The purpose of this study was to understand the molecular epidemiology of tuberculosis in Khorasan province of Iran was studied by spoligotyping 113 Mycobacterium tuberculosis isolates. The spoligotyping results were in comparison to the word Spoligotyping Database of Institute Pasteur de Guadeloupe (SpolDB4). Spoligotyping data from Iran has rarely been described and there is limited information on the major circulating clades of M. tuberculosis in Iran. Materials and Methods: Spoligotyping was performed on 113 M. tuberculosis isolates from Mashhad patients between November 2004 and September 2005. Results: The study found 57 spoligopatterns. 17 clusters and 32 true orphan genotype. The biggest cluster with 13 isolates had not been previously reported. The Beijing genotype was seen in eight (7.1%) isolates. Conclusions: Genotyping and Spoligotyping gives a unifying framework for both epidemiology and evolutionary analysis of M. tuberculosis populations.
  5 4,560 462
Hantavirus species in India : A retrospective study
S Chandy, M Okumura, K Yoshimatsu, RG Ulrich, GT John, P Abraham, J Arikawa, G Sridharan
October-December 2009, 27(4):348-350
DOI:10.4103/0255-0857.55456  PMID:19736405
Hantaviruses cause hemorrhagic fever with renal syndrome in Europe and Asia. There are about 20 documented hantavirus species and newer species are being described worldwide, especially in non-rodent reservoirs, i.e shrews. Focus reduction neutralization test is the classical serotyping technique for hantavirus. However, this study employs a previously established serotyping ELISA, to retrospectively analyze known hantavirus IgG reactive samples for infecting serotypes. The result suggests presence of Thailand virus- like and Hantaan virus -like strains in India.
  4 3,719 412
The role of active efflux in antibiotic - resistance of clinical isolates of Helicobacter pylori
T Falsafi, A Ehsani, V Niknam
October-December 2009, 27(4):335-340
DOI:10.4103/0255-0857.55452  PMID:19736403
Purpose: In gram-negative bacteria, active efflux pumps that excrete drugs can confer resistance to antibiotics however, in Helicobacter pylori this role is not well established. The purpose of this study is to evaluate the role of active efflux in resistance of H. pylori isolates to antibiotics. Materials and Methods: Twelve multiple antibiotic resistant (MAR) isolates resistant to at least four antibiotics, including β-lactams, metronidazole, tetracycline, erythromycin, and ciprofloxacin; three resistant to only β-lactams, and two hyper-susceptible isolates, were obtained from screening of 96 clinical isolates of H. pylori . Their minimal inhibitory concentrations (MICs) for antibiotics and ethidium-bromide (EtBr) were compared in the presence- and absence of a proton-conductor, carbonyl cyanide-m chlorophenyl-hydrazone (CCCP) using agar-dilution and disc diffusion. Drug accumulation studies for EtBr and antibiotics were assessed in the presence and absence of CCCP using spectrofluorometry. Results: MIC of EtBr for eight MAR-isolates was decreased two- to four-folds in the presence of CCCP, of which five showed reduced MICs for β-lactam, metronidazole, tetracycline, and ciprofloxacin with CCCP. Accumulation of EtBr by the MAR-isolates was rapid and not dependant on the pattern of multiple resistance. Antibiotic accumulation assay confirmed the presence of energy-dependant efflux of β-lactam, metronidazole, tetracycline, and ciprofloxacin, but no erythromycin in five MAR isolates. Energy-dependant efflux of EtBr or antibiotics was not observed for four MAR-isolates, and three isolates were resistant only to β-lactams. Conclusion: Energy-dependant efflux plays a role in the resistance of H. pylori clinical isolates to structurally unrelated antibiotics in a broadly specific multidrug efflux manner. Difference in the efflux potential of MAR isolates may be related to the presence or absence of functional efflux-pumps in diverse H. pylori isolates.
  4 4,907 513
Oral fluid, a substitute for serum to monitor measles IgG antibody?
A Goyal, NJ Shaikh, AA Kinikar, NS Wairagkar
October-December 2009, 27(4):351-353
DOI:10.4103/0255-0857.55457  PMID:19736406
We have analyzed the suitability and potential of Oral Fluid (OF) to substitute serum in estimating measles IgG antibodies, during community surveys, by comparing the Optical Density (OD) of measles IgG antibodies in OF and serum of 100 apparently asymptomatic children. IgG antibody status was determined using commercially available - Measles IgG Capture ELISA. Sensitivity 89.5%, specificity 90.6% Concordance of 89%, coefficient of correlation r is equal to 0.97 (Karl Pearson's) and rho is equal to 0.86 (Spearman's), was found between OD value of OF and serum. The study emphasizes the potential of OF to surrogate serum in estimating Measles IgG antibody among children. The OF collection is advantageous over blood as it is painless. It is suitable for non-technical staff, easy to transport and less bio-hazardous.
  3 3,680 300
A rare case of tubercular cerebellar abscess
K Wanjari, VP Baradkar, G Nataraj, S Kumar
October-December 2009, 27(4):363-365
DOI:10.4103/0255-0857.55464  PMID:19736410
Tubercular brain abscess are uncommon and tubercular cerebellar abscess are rarely reported. Most of these cases occur in immunocompromised patients. We report a case of multiple cerebellar abscesses in a 55-year-old HIV seronegative non-diabetic female, who complained of headache, neck pain and unsteadiness of gait since two months. She had been on treatment for pulmonary tuberculosis, diagnosed earlier. Diagnosis was made by CT scan of brain and confirmed by bacteriological examination of drained pus obtained by suboccipital craniotomy. The patient showed signs of recovery.
  3 4,684 310
Vancomycin resistant enterococci in a tertiary care hospital in Mumbai
A De, A Bindlish, S Kumar, M Mathur
October-December 2009, 27(4):375-376
DOI:10.4103/0255-0857.55451  PMID:19736416
  3 4,853 638
Characterization and anti - microbial susceptibility of gram - negative bacteria isolated from bloodstream infections of cancer patients on chemotherapy in Pakistan
S Saghir, M Faiz, M Saleem, A Younus, H Aziz
October-December 2009, 27(4):341-347
DOI:10.4103/0255-0857.55454  PMID:19736404
Purpose: Bloodstream infection remains a major cause of morbidity and mortality in patients undergoing treatment for cancer. Severe infections due to Gram-negative bacilli & staphylococci are common in cancer patients. Altered gut flora because of frequent antibiotic administration and damage of epithelial surfaces contribute to the development of infection. To access the use of new potent antibiotics against bloodstream infection in cancer patients and to determine the cross resistance of Gram-negative bacterial strains. Materials and Methods: We studied the bacterial spectrum & antimicrobial susceptibility pattern of cephalosporins, fluoroquinolones, carbapenems and aminoglycosides against Gram-negative bacterial strains in cancer patients. The susceptibility was determined by broth dilution method according to National Committee for Clinical Laboratory Standards (NCCLS) now called Clinical Laboratory Standards Institute (CLSI) during study period (July 2006 to Jan 2007). Results: A total of 60 Gram-negative bacterial blood cultures were examined. Among these, Pseudomonas aeruginosa was the most common (38%). The Minimum Inhibitory Concentration at which 50% (MIC 50 ) and 90% (MIC 90 ) of Enterobacteriaceae and P. aeruginosa inhibited were found. Resistance in P.aeruginosa against cefepime, meropenem, ciprofloxacin, ceftriaxone, tobramycin, cefoperazone and imipenem was 60%, 13%, 80%, 67%, 40%, 90% and 10% respectively while for Enterobacteriaceae 80%, 20%, 88%, 72%, 20%, 90% and four per cent resistance was observed. Meropenem was found to be the most effective antimicrobial against Gram-negative bacteria. Conclusion: High resistance observed in this study warrants the needs of surveillance of resistant pattern of antimicrobial agents. Due to increased level of drug resistance, carbapenem would be a prudent choice in high- risk cases.
  3 6,177 1,009
Female genital TB and HIV co-infection
S Duggal, N Duggal, C Hans, RK Mahajan
October-December 2009, 27(4):361-363
DOI:10.4103/0255-0857.55461  PMID:19736409
HIV-induced immunosuppression paves the way for several infections, tuberculosis being very common in our country. Female genital tuberculosis (FGTB), presenting as menstrual irregularities, is a diagnostic challenge in an adolescent female when these may be considered normal. The present case is of a young female who presented with menstrual irregularities, diagnosed subsequently as a case of genital tuberculosis. Microbiological relapse after anti-tubercular treatment of six months caused suspicion of a co-existing immunodeficiency and investigations revealed HIV co-infection; thus emphasizing the need of HIV testing in all patients of tuberculosis for timely diagnosis and treatment support thereafter.
  2 4,893 430
Potential of biofilm formation by staphylococci on polymer surface and its correlation with methicillin susceptibility
A Chaudhury, M Nagaraja, AG Kumar
October-December 2009, 27(4):377-378
DOI:10.4103/0255-0857.55450  PMID:19736417
  2 3,111 477
Comparative in vitro antimicrobial activity of tigecycline against clinical isolates of vancomycin-resistant enterococcus
M Yemisen, A Demirel, B Mete, A Kaygusuz, A Mert, F Tabak, R Ozturk
October-December 2009, 27(4):373-374
DOI:10.4103/0255-0857.55455  PMID:19736414
  2 3,167 407
Anti - microbial resistance stratified by risk factor among Escherichia coli strains isolated from the urinary tract at a rural clinic in Central India
B Chatterjee, S Kulathinal, A Bhargava, Y Jain, R Kataria
October-December 2009, 27(4):329-334
DOI:10.4103/0255-0857.55449  PMID:19736402
Background: The failure of empirical therapy is frequently observed, even in community-acquired urinary tract infections. We, therefore, conducted a prospective, clinic-based study in 2004-2005 to document anti-microbial resistance rates and correlate them with possible risk factors to assist empirical decision-making. Materials and Methods: Symptomatic patients with pyuria underwent urine culture. Isolates were identified using standard methods and anti-microbial resistance was determined by disk-diffusion. Ultrasonography was used to detect complicating factors. Patients were stratified by the presence of complicating factors and history of invasive procedures for comparison of resistance rates. Statistical Method Used: Chi-square or Fisher exact tests, as appropriate. Results: There were 156 E. coli isolates, of which 105 were community-acquired. Twenty-three community-acquired isolates were from patients with complicating factors while 82 were from patients without any. Fifty-one isolates were from patients who had recently undergone invasive procedures on the urinary tract. Thirty-two community-acquired isolates from reproductive-age women without apparent complicating factors had resistance rates of 50% or above against tetracyclines, Co-trimoxazole, aminopenicillins, Nalidixic acid, Ciprofloxacin and 1 st generation cephalosporins. Resistance rates were significantly higher among isolates from patients subjected to invasive procedures, except against Co-trimoxazole, tetracyclines and Amikacin. Conclusion: High rates of anti-microbial resistance in community-acquired uropathogens have made antimicrobial sensitivity testing necessary even in a rural, primary-care setting.
  2 5,658 779
Characterization of leptospires using V3 region of 16S rDNA by denaturing gradient gel electrophoresis : A case study
SS Pol, PK Dhakephalkar, RS Bharadwaj
October-December 2009, 27(4):354-357
DOI:10.4103/0255-0857.55459  PMID:19736407
Serological and molecular characterization of Leptospiral isolates helps us to identify serovar, which is useful, for epidemiological study. Serological characterization is tedious and requires a panel of monoclonal antibodies and expertise to read the results. This study is a preliminary work to evaluate the usefulness of Denaturing Gradient Gel Electrophoresis (DGGE) to identify serovars of leptospira. The V3 region of most conserved 16S rDNA of five pathogenic leptospiral serovars and one saprophytic serovar was characterized. DGGE method was employed to separate the amplified V3 region based on the nucleotide sequence. On DGGE, amplified V3 region of leptospiral serovars, under study, showed bands at different positions indicating DGGE as the effective method of characterization in the future. DNA sequencing of V3 region of the three serovars showed great difference in nucleotide sequence supporting the results of DGGE.
  1 4,477 298
Cefoxitin disk diffusion test - Better predictor of methicillin resistance in Staphylococcus aureus
M Gupta, NP Singh, A Kumar, IR Kaur
October-December 2009, 27(4):379-380
DOI:10.4103/0255-0857.55447  PMID:19736419
  1 7,556 675
Effect of stress on production of heat labile enterotoxin by Escherichia coli
A Hegde, GK Bhat, S Mallya
October-December 2009, 27(4):325-328
DOI:10.4103/0255-0857.55446  PMID:19736401
Enterotoxigenic Escherichia coli (ETEC) is an important pathogen responsible for secretory diarrhoea. The production of heat labile enterotoxin (LT), by ETEC, is largely responsible for the pathogenesis of diarrhoea. In the present study we investigated the effect of stress factors such as temperature, pH, osmotic stress and nutritional limitation on the production of LT by ETEC using in-house GMI-ELISA. Four strains of E. coli consisting, one standard strain MTCC 723 and three clinical isolates were used in the study. Maximum amount of LT (OD 3.285) was produced at 37 0 C followed by 40 0 C (OD 3.305). Growth of E. coli in medium with pH 8.6 resulted in maximum amount of LT production (OD 3.489). LT was not detectable when bacteria were grown in medium with pH ≤7.2 and ≥ 9.2. Sodium chloride concentration of 0.2 M stimulated maximum amount of LT production. Maximum amount of LT was produced when the bacteria were grown in medium containing 2.5g/l of glucose. All the stress factors had a significant effect on the LT production by E. coli , though quantitative differences in the various strains were observed.
  1 5,058 526
Genetic diversity among toxigenic clostridia isolated from soil, water, meat and associated polluted sites in South India
S Sathish, K Swaminathan
October-December 2009, 27(4):311-320
DOI:10.4103/0255-0857.55443  PMID:19736399
Purpose: To investigate the genetic diversity of toxigenic Clostridium strains isolated from soil, water, meat and its associated polluted sites of Southern India. Materials and Methods: A total of 27 identified isolates of six different toxigenic clostridial species including C. bifermentans , C. botulinum , C. chauvoei , C. ramosum , C. tetani and C. novyi were isolated and characterized by conventional DNA restriction digestion analysis (REA) and by whole-cell and excretory protein patterns on SDS-PAGE. Results: The DNA fragment size ranged from 35-160 kilobases and the protein bands 30-200 KDa, followed by numerical analyses and phylogenetic analyses. Whole-cell protein banding pattern were unique with strains of C. chauvoei , C. novyi and C. ramosum . All the strains were heterogeneous and distinct in restriction digestion pattern and excretory protein patterns. Conclusion: These analyses contribute to the understanding of prevalence of toxigenic clostridial species and phylogeny within the species and assist in development of improved diagnostics and therapeutics for the treatment of clostridial infections.
  1 5,066 415
Antimicrobial resistance - The modern epidemic current status and research issues
Reba Kanungo
October-December 2009, 27(4):386-387
  - 2,668 487
S Jayachandran
October-December 2009, 27(4):387-387
  - 2,095 234
Salmonella enterica serotype dublin bacteraemia mimicking enteric fever
M Dias, B Antony, H Pinto, B Rekha
October-December 2009, 27(4):365-367
DOI:10.4103/0255-0857.55463  PMID:19736411
Salmonella enterica serotype Dublin, a bovine adapted serotype, is the commonest cause of salmonellosis in cattle. Salmonellosis in animals always presents a potential zoonotic threat. Infected cattles serves as a source of infection to humans. We present here Salmonella Dublin Bacteraemia in an elderly patient, with all the clinical details, due to the rarity of its occurrence. He was treated successfully with ciprofloxacin and his follow up period was uneventful.
  - 3,743 292
Laboratory microbiology to clinical microbiology: Are we ready for a transition?
K Kapila, K Kaushik
October-December 2009, 27(4):378-379
DOI:10.4103/0255-0857.55448  PMID:19736418
  - 2,180 309
Calvarial tubercular osteomyelitic abscess
A Rajesh, AK Purohit, V Lakshmi
October-December 2009, 27(4):380-381
DOI:10.4103/0255-0857.55444  PMID:19736420
  - 2,346 167
An unusual presentation of Wuchereria bancrofti infection
V Rawat, G Rizvi, N Sharma, H Pandey
October-December 2009, 27(4):382-383
DOI:10.4103/0255-0857.55442  PMID:19736421
  - 2,782 251
Pilot evaluation of commercial liquid culture method for isolation of mycobacteria in resource-poor settings
RK Sharma, KP Rajput, ND Kothari, V Nerurkar, SS Malvankar
October-December 2009, 27(4):374-375
DOI:10.4103/0255-0857.55453  PMID:19736415
  - 2,663 272
Women in medical microbiology: Reflections on contributions
K Kaushik, K Kapila
October-December 2009, 27(4):285-288
DOI:10.4103/0255-0857.55435  PMID:19736395
  - 12,176 952
The poem syndrome
P Desikan
October-December 2009, 27(4):384-385
  - 3,951 319

2004 - Indian Journal of Medical Microbiology
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