Beena Antony

food PoIsonIng duE to SALMONELLA ENTERICA sErotYPE WEltEvrEdEn In mangalorE

An outbreak of food poisoning due to Salmonella enterica serotype Weltevreden ( S.weltevreden ) involving 34 students has been reported from a tertiary care hospital in Mangalore. The symptoms developed 8-10 hours, after consuming a non- vegetarian dish, probably fish, from an outside caterer. The identity of the organism was confirmed at Central Research Institute, Kasauli. This report emphasizes the geographical distribution of this organism in the Coastal Karnataka region. S.Weltevreden may be overlooked due to the biochemical similarity to S. Paratyphi B & S. Typhimurium.

An outbreak of neonatal septicaemia by Enterobacter cloacae

Objective To report an outbreak of Enterobacter cloacae (E. cloacae) in a neonatal intensive care unit of a rural hospital in Karnataka and conduct a prospective study on neonatal septicaemia.

Antibiogram of salmonella isolates from blood with an emphasis on nalidixic Acid and chloramphenicol susceptibility in a tertiary care hospital in coastal karnataka: a prospective study.

Background: Enteric fever is caused by the serotypes Salmonella Typhi, Salmonella Paratyphi A, Salmonella Paratyphi B and Salmonella Paratyphi C. After emergence of multidrug resistant Salmonellae Ciprofloxacin, a fluorquinolone antibiotic was the first-line therapy. Treatment failure was observed with Ciprofloxacin soon and such strains showed in-vitro resistance to Nalidixic acid. Recent reports suggest re-emergence of Chloramphenicol sensitive strains and increasing Nalidixic acid resistance. This study is aimed at detecting the current trend in the antibiogram of Salmonella isolates from blood culture in coastal Karnataka, with an emphasis on antibiotic susceptibility of Nalidixic acid and Chloramphenicol and evaluate, if there is a need to modify the strategies in the antibiotic therapy for enteric fever. Materials and Methods: Blood samples received for culture in the laboratory between June 2009 and August 2011 was cultured in Brain Heart infusion broth, bile broth or in a commercial BACTEC culture media. The growth from blood cultures were processed for identification and antibiotic susceptibility as per standard methods. Antibiotic susceptibility for Ampicillin, Trimethoprim-sulphamethoxazole, Chloramphenicol, Ciprofloxacin, Ceftriaxone and Nalidixic acid were noted. Results: Out of 9053 blood culture specimens received, Salmonella was isolated from 103 specimens. There were 85 Salmonella Typhi isolates, 16 Salmonella Paratyphi A and two Salmonella Paratyphi B. Salmonella Typhi and Salmonella Paratyphi A showed the highest resistance to Nalidixic acid. Salmonella Typhi showed highest susceptibility to Ceftriaxone and Salmonella Paratyphi A to trimethoprim-sulphamethoxazole and Chloramphenicol. Two isolates were multidrug resistant. One Salmonella Paratyphi A was resistant to Ceftriaxone. Conclusion: Routine screening of Nalidixic acid susceptibility is practical to predict fluorquinolone resistance in Salmonella and preventing therapeutic failure while treating with it. It is worthwhile to consider replacing fluorquinolones with Chloramphenicol or Ceftriaxone as the first line of therapy for enteric fever. Periodic analysis of Salmonella antibiogram should be done to formulate the best possible treatment strategies.

A sporadic outbreak of Burkholderia cepacia complex bacteremia in pediatric intensive care unit of a tertiary care hospital in coastal Karnataka, South India

Burkholderia cepacia complex (BCC) is a significant opportunistic pathogen in hospitalized and immunocompromised patients, particularly in cystic fibrosis. It is widely distributed in natural habitats such as soil and water and frequently encountered in nosocomial outbreaks due to contaminated disinfectants and medical devices. However reports on outbreaks due to this organism are lacking from the Indian subcontinent. We report here a sporadic outbreak due to BCC which occurred in the pediatric Intensive Care Unit of our institute, the probable source being contaminated distilled water. The isolate from three babies and environmental sources including distilled water were identical and confirmed as BCC. Strict infection control measures were instituted to prevent the spread of infection. This report highlights the potential role of B.cepacia in causing sporadic outbreaks especially in ICUs, associated with water.

Bacterial spectrum of neonatal septicemia with their antibiogram with reference to various predisposing factors in a tertiary care hospital in Southern India

Background: Various factors predispose to neonatal septicemia (NS) and study of these factors and a change in bacterial spectrum and antimicrobial susceptibility pattern was noticed in this study, which will certainly help in treatment of septicemic neonates. Objective: To isolate the causative agents of NS, antimicrobial susceptibility pattern of the isolates and to analyze the various predisposing factors to NS. Materials and Methods: Study was done over a period of two years. Blood samples from 200 clinically suspected NS cases were subjected to aerobic culture and their antimicrobial susceptibility pattern was determined. History of sex, gestational age, birth weight, term or preterm, outborn, or inborn babies were taken. Results: Of 200 cases, 95 (47.5%) were blood culture positive. Of them, 64 (67.37%) were males, 64 (67.37%) were preterm, birth weight <1.5 kg were 41 (43.16%), 71.58% outborn neonates with 55.79% mortality rate. Gram-negative isolates were 67 (70.53%) and Gram-positive isolates were 28 (29.47%). Enterobacter cloacae and Staphylococcus aureus were commonest isolates in 20% and 11.58% of cases, respectively. Gram-negative isolates were sensitive to amikacin, ciprofloxacin, and ofloxacin and least sensitive to ampicillin and amoxiclav. All Gram-positive isolates were sensitive to vancomycin. Conclusion: NS was found to be 47.5% in our study. In this study, we have analyzed various predisposing factors of NS. Blood culture is the gold standard for diagnosis of NS. A change in bacterial spectrum and change in their antimicrobial susceptibility pattern was noticed in this study, which will certainly help in treating such cases.

Salmonella wien from gastroenteritis cases encountered in Mangalore, India : A report of 10 cases and review of the literature

Ten cases of gastroenteritis due to S. Wien were reported from a tertiary care hospital in Mangalore, in the month of April 2008. Biochemically, it resembles S. Paratyphi B or S. Typhimurium. Serotyping was done at the Central Research Institute, Kasauli, to confirm the identity. The food source is more likely to be chicken or some poultry products. All the 10 cases recovered with symptomatic treatment including antimicrobials like fluoroquinolones. To the best of our knowledge, no documented report is available from India regarding the prevalence of this organism in humans.

Detection of Rotavirus and Adenovirus diarrhea in children below five years, in Dakshina Kannada District, a coastal region of Karnataka State, India

Context: Diarrheal disease is the second largest cause of death of children under 5 years. Viral diarrhea is most common which is usually caused by Rotavirus followed by enteric Adenovirus. Rotaviruses are responsible for approximately 527,000 deaths mainly in low-income countries of Africa and Asia. There is limited number of studies done on viral diarrhea in this coastal belt. Aim: To determine the prevalence of Rotavirus and Adenovirus diarrhea among children below 5 years of age and its epidemiological importance in this coastal region of Karnataka State, India. The impact of factors like socio-economic status, drinking water, and Rotavirus immunization status that can contribute to the disease were also evaluated and recommendations are formulated for disease prevention. Materials and Methods: Children below 5 years of age with history of diarrhea, vomiting and fever of less than 3 days were included in this study. The sample size was 35. General physical examination, clinical findings and other details like socio-economic status, personal hygiene, growth milestones and family income were also recorded. A commercial Rotavirus and Adenovirus antigen detection kit was used to detect the presence of Rotavirus and Adenovirus antigen from the stool sample. Results: Out of 35 patients screened, 25 (71.43%) patients were negative for both Adenovirus and Rotavirus, 10 children (28.57%) were positive for Rotavirus and no patients were positive for Adenovirus. Severe dehydration, fever, loose stools and vomiting were the commonest symptoms seen in Rotavirus positive children. The highest incidence of infection with Rotavirus was seen among 7-12 months age group. Children whose stool was positive for Rotavirus used public water supply. Conclusions: Rotavirus is an important cause of diarrhea in children below 5 years in this coastal region. A simple, rapid immunochromatography test is useful and economical tool to simultaneously detect and screen Adenovirus and Rotavirus. Low socioeconomic state and unsafe water supply contributes to diarrheal disease.

Salmonella enterica serotype dublin bacteraemia mimicking enteric fever

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.

Seroprevalence of hepatitis B virus/hepatitis C virus among human immunodeficiency virus-infected patients at a tertiary care teaching hospital in Mangalore, South India

Background: The human immunodeficiency virus (HIV) pandemic has continued to be a major public health problem even after more than three and a half decade of existence. According to the World Health Organization estimates, 36.7 million people were living with HIV by 2015 end while chronic infection of hepatitis B virus (HBV) and hepatitis C virus (HCV) occurs in 240 and 130–150 million people worldwide, respectively. Since the general modes of transmission are similar to HIV, coinfection of HIV with HBV/HCV is commonly found, being variable worldwide. Aims and Objectives: The aims and objectives of this study were (1) To investigate the seroprevalence of HBV/HCV in HIV-positive patients and (2) To analyze the demographic pattern and laboratory parameters. Settings and Design: This was a descriptive cross-sectional study. Materials and Methods: The serum samples from confirmed HIV-positive patients were screened and confirmed for HBV and HCV following standard operative procedures. The demographic pattern and laboratory parameters were also obtained. Statistical Analysis Used: SPSS software version 23.0 was used for statistical analysis. Results: The seroprevalence of HBV and HCV in HIV-positive patients was found to be 6.6% and 0.7%, respectively. Males (n = 7) were more commonly infected than females (n = 3) with the age group of 31–40 years being the most common and majority were married (n = 9). In HBV-HIV coinfection, the mean values of serum globulin, serum total bilirubin, conjugated bilirubin, aspartate amino-transferase, alanine aminotransferase (ALT), and alkaline phosphatase were increased, but in the only case of HCV-HIV coinfection, only hemoglobin and platelet count were decreased. A majority (n = 8) improved on discharge. Conclusions: The seroprevalence of HBV/HCV was high with laboratory test showing a significant correlation between HBV-HIV coinfection and serum globulin and ALT. Hence, creating awareness, understanding these diseases, and providing screening test in suspected individuals is the need of the hour which will improve the mortality rates related to them.

Spectrum of anaerobes encountered in surgical infections in a tertiary care hospital in Mangalore, coastal Karnataka: A prospective study

Context: Anaerobes are significant pathogens as well as normal flora in a variety of body sites. As the conventional anaerobic culture techniques are laborious, time-consuming and relatively expensive, the interest in anaerobes started narrowing down in the recent past. Objective: This study is aimed at the isolation of bacteria encountered in the surgical infections with an emphasis on anaerobes and to create an awareness among the clinicians regarding the potential role of these silent pathogens Materials and Methods: The present prospective study that was conducted for a period of 1 year, employed 393 specimens collected from various surgical infections. All the samples were subjected for the isolation of both aerobes and anaerobes. Results: Out of 393 specimens, 193 anaerobes and 311 aerobes were obtained. Majority of the cases (226) exhibited polymicrobial etiology. Among the anaerobes, more frequently isolated organisms were nonsporing gram-negative bacilli, such as Bacteroides fragilis group, Prevotella-Porphyromonas group and Fusobacterium, which constitute 68.91% of the cases. Conclusions: This study emphasizes the need to employ anaerobic culture techniques routinely in microbiology laboratories and to create an awareness among the clinicians regarding the potential role of anaerobes.