Ashish Khanna

Serratia marcescens- a rare opportunistic nosocomial pathogen and measures to limit its spread in hospitalized patients.

BACKGROUND In November 2011, 6 patients who were in the ICU of the Sri Guru Ram Dass Institute of Medical Sciences and Research acquired an infection which was caused by Serratia marcescens. We investigated the cause of the increase in frequency of the isolation of Serratia marcesens from hospitalized patients. METHODS Various samples from patients and environmental sources, which were collected from the ICU of Sri Guru Ram Das Institute of Medical Sciences and Research during the 6 month period from November 2011 to April 2011, were included in the study. The isolates from the patients and the surrounding environmental sources were examined by using standard techniques. Further, the isolates of Serratia marcescens were identified, depending upon their biochemical and morphological characteristics. RESULTS Seven isolates of Serratia marcescens were identified (six from the patients in the ICU and one from the soap dispenser in the ICU) among a total of 327 isolates from the clinical samples and 84 isolates were identified from the environmental sources in the ICU. DISCUSSION AND CONCLUSION An outbreak of the Serratia marcescens infection in the ICU was traced to the extrinsic contamination of the soap dispenser in the ICU, as after the removal of the dispenser, no further case occurred.

Sclerosing Stromal Tumor of Ovary: A Case Report

Sclerosing stromal tumor (SST) is an extremely rare and distinctive sex cord stromal tumor which occurs predominantly in the second and third decades of life. We report a case of a 32-year-old woman who developed a sclerosing stromal tumor of ovary and presented with irregular menstruation and pelvic pain. Her hormonal status was normal but CA-125 was raised. She was suspected to have a malignant tumor on computed tomography and underwent bilateral salpingo-oopherectomy. It is therefore necessary to keep in mind the possibility of sclerosing stromal tumor in a young woman.

Carcinosarcoma of the Gallbladder: A Case Report and Review of the Literature

A carcinosarcoma is a rare type of gallbladder malignancy, the diagnosis of which requires the presence of both malignant epithelial and mesenchymal components. The prognosis of this disease is extremely poor because it normally presents at advanced stages.We are reporting a case of carcinosarcoma of the gallbladder in a 45 year-old woman who was treated by cholecystectomy, as the tumour was confined to the gall bladder only.

Comparative Evaluation of Tubex TF (Inhibition Magnetic Binding Immunoassay) for Typhoid Fever in Endemic Area

BACKGROUND Typhoid fever remains a significant health problem in endemic countries like India. Various serological tests for the diagnosis of typhoid fever are available commercially. We assessed the usefulness of rapid test based on magnetic particle separation to detect Immunoglobulin against Salmonella typhi O9 lipopolysaccharide. AIM Aim of this study was to compare the sensitivity and specificity of widal test, typhidot and tubex TF test for the diagnosis of typhoid fever in an endemic country like India. MATERIALS AND METHODS Serum samples collected from 50 patients of typhoid fever, 50 patients of non typhoid fever and 100 normal healthy individuals residing in Amritsar were subjected to widal test, typhidot test and tubex TF test as per manufacturers instructions. Data collected was assessed to find sensitivity and specificity of these tests in an endemic area. RESULTS Significant widal test results were found positive in 68% of patients of typhoid fever and only 4% of non typhoid fever patients. Typhidot (IgM or IgG) was positive in 72% of typhoid fever patients and 10% and 6% in non typhoid fever and normal healthy individuals respectively. Tubex TF showed higher sensitivity of 76% and specificity of 96-99% which was higher than typhidot and comparable to widal test. CONCLUSION This was the first evaluation of rapid tubex TF test in northern India. In countries which can afford high cost of test, tubex TF should be recommended for the diagnosis in acute stage of the disease in clinical setting. However, there is urgent need for a highly specific and sensitive test for the diagnosis of typhoid fever in clinical settings in endemic areas.

Assessment of Rapid Dipstick Test for Diagnosis of Urinary Tract Infection in Asymptomatic Pregnant Female

Background: Bacteriuria during pregnancy has been known to cause many complications like low birth weight and premature delivery. Objective : This study was done to evaluate the diagnostic accuracy of rapid dipstick test to predict urinary tract infection in pregnancy against the gold standard urine culture. Material&Methods: A total of 200 mid stream urine samples were collected from asymptomatic pregnant females. These specimens were cultured in blood agar and MacConkeys agar by using the standard loop technique and incubated aerobically at 37°C overnight. The criterion for clinically significant bacteriuria was either a pure or predominant culture of >10 5 colony forming units (CFU)/ml. All the specimens were also examined microscopically for pyuria and bacteriuria. Results: The prevalence of asymptomatic bacteriuria in pregnancy was 15 % in our study. The sensitivity and the specificity for leucocyte esterase were 85.7% and 74.4% and for nitrites, they were 64.2% and 72%. Conclusion: The study revealed that use of either leukocyte esterase or nitrite for screening of asymptomatic bacteriuria in pregnancy was associated with many false positive and negative results when compared with the gold standard urine culture method. By using their combination maximum negative predictive value of .98 was achieved.

ESBL Producing Gram Negative Bacteria-A Cause of Concern in Neonatal Septicemia in a Tertiary Care Hospital

ISSN: 2319-7706 Volume 5 Number 10 (2016) pp. 807-813 Journal homepage: http://www.ijcmas.com Neonatal septicaemia is the leading cause of death in neonates admitted in the neonatal intensive care unit in India. Furthermore this situation is nowadays worsened by the beta lactamase producing bacteria occurring as a causative agent of neonatal septicaemia. These ESBL producing gram negative organisms with increased resistance should be monitored regularly and antibiogram prepared so as to plan effective empiric therapy. Aim of this study was to determine the bacteriological spectrum and resistance pattern of these gram negative isolates from neonatal intensive care unit. ESBL production among these gram negative organisms was also determined. A study was done in the department of Microbiology of our medical college where 282 neonates admitted in the neonatal intensive care unit between june 2016 to august 2016 with suspicion of septicaemia were included in the study. About 2ml of blood was collected under aseptic condition and put in Bact T Alert PF plus bottles (paediatric bottles) for culture. Gram negative isolates recovered from these septicemic patients were further tested for the presence of ESBL and resistance pattern. Among the 282 suspected patients of neonatal septicaemia, blood culture was positive in 89 patients. Gram negative isolates were seen in 48 cases whereas gram positive isolates were seen in 22 cases. Candida species were isolated from 19 cases of neonatal septicaemia. Most common gram negative organism isolated was Klebsiella species (22.2%). ESBL production was there in 39.6% of the gram negative isolates. Multidrug resistance was more common in ESBL producers than Non ESBL producers. Septicaemia in neonates is increasing rapidly in India. ESBL producing gram negative organisms are also increasing with alarming proportion throughout the world. As the gold standard for the diagnosis of septicemia is culture which takes about 48-72 hours so precious time is lost in the diagnosis. Clinician has to rely on the empirical therapy till the result of the culture is obtained. Empiric therapy should be based on the knowledge of prevalence of beta lactamases in that hospital. Bacteriological profile of neonatal septicaemia also varies in different regions of the vast country like India. K e y w o r d s ESBL, Neonatal septicemia,