Charoo Hans

Fatal Case of Salmonella enterica subsp. arizonae Gastroenteritis in an Infant with Microcephaly

ABSTRACT Salmonella enterica subsp. arizonae is a common gut inhabitant of reptiles, with snakes as the most common reservoir. Though human cases due to this organism are exceedingly rare, it may infect young infants and immunocompromised individuals with a history of intimate associations with reptiles. Gastroenteritis is the most common presentation; others include peritonitis, pleuritis, osteomyelitis, meningitis, and bacteremia. We report a fatal case of S. enterica subsp. arizonae gastroenteritis in a 3-month-old child with microcephaly, with a review of earlier cases and problems encountered in identification of this rare human pathogen.

Urinary Tract Infection: Aetiology and Antimicrobial Resistance Pattern in Infants From A Tertiary Care Hospital in Northern India

INTRODUCTION Urinary tract infection (UTI) is one of the most common bacterial infections in childhood. Present study was undertaken to determine the occurrence of the uropathogens and their antimicrobial susceptibility pattern in infants (< 1yr) suspected with UTI. MATERIALS AND METHODS This study was conducted in the Microbiology Department on urine samples received from infants for a period of two years from September 2011 to August 2013. RESULTS Culture positivity rate was found to be 15.7%. There was an overall male preponderance in cases of UTI (70.1%). Most common bacterial isolate was E.coli (45.4%) followed by Klebsiella (16.7%) and Enterococcus spp (13.2%). Isolation of candida was 21.1%, maximum from ICU (63.1%). Maximum gram negative isolates (50%) showed high resistance to gentamicin, amikacin, cefotaxime and norfloxacin while most of the isolates (5%) were found susceptible to nitrofurantoin and piperacillin-tazobactam. 45.1% of gram negative bacilli were ESBL producer. We recommend continuous monitoring of changes in bacterial pathogens causing UTI and antibiotic sensitivity in each area for effective treatment of UTI. CONCLUSION Since antimicrobial resistance is a major problem, such study will help in formulating a strict antibiotics prescription policy in our country.

Female genital TB and HIV co-infection

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.

Case of sparganosis: a diagnostic dilemma.

Sparganosis, also known as larval diphyllobothriasis, is a rare disease of humans as man is not a natural host in the life cycle of Spirometra spp. Diagnosis of the latter is difficult as it mimics other conditions that commonly cause subcutaneous or visceral fluid collection. Clinical diagnosis of this particular case was also erroneously labelled as tuberculosis but later labelled as a case of sparganosis. To the best of our knowledge, this is the first case from India where a sparganum-like parasite was isolated in drain fluid from the perinephric area.

Rhinocerebral zygomycosis with pulmonary aspergillosis in a non-HIV-infected patient: an unusual case report from India

Zygomycosis and aspergillosis are two serious opportunistic fungal infections that are commonly seen in immunocompromised patients. Since both these fungi invade vessels of the arterial system, an early and rapid diagnosis by direct examination of KOH mounts of the relevant clinical sample can confirm the diagnosis. Here, we present an unusual case of a diabetic patient who presented with nasal blockade and bleeding for 2 months, along with occasional haemoptysis for 15 days. On investigation, the patient was diagnosed with a case of rhinocerebral zygomycosis and was treated with amphotericin B (1 mg kg(-1) day(-1)), which was subsequently replaced with liposomal amphotericin B (2 mg kg(-1) day(-1)). However, the patient did not completely respond to therapy as haemoptysis continued. Further investigations revealed the presence of Aspergillus flavus in respiratory specimens. Thus, a final diagnosis of rhinocerebral zygomycosis with pulmonary aspergillosis in a non-HIV-infected patient was made, but due to infection of two vital sites by these fungi, the patient could not be saved.

Septic arthritis due to Salmonella Typhi in children—A case series

In this work, we isolated and characterized the first factor X activator from Bothropoides jararaca (= Bothrops jararaca ) venom, Bojaractivase X, which is probably involved in the genesis of the envenomation process. Bojaractivase X was purified by a combination of gel filtration and ion exchange chromatographies on Superdex HR 75 10/30 and HiTrap SP FF, respectively. Bojaractivase X consists of a single polypeptide chain with molecular mass of 28 kDa determined by SDS-PAGE. The enzyme shows maximum activity on factor X activation at pH 7.0 and 37°C. The activator converts factor X to its active form, factor X a , in the presence of Ca 2+ ions. Bojaractivase X also degrades the Aα, Bβ and γ -chain of fibrinogen molecule as well as casein. Inhibition of Bojaractivase X amidolytic activity by benzamidine suggests that it is a serine proteinase. Mass spectrometry analysis showed similarity between Bojaractivase X and a venom serine protease homolog from B. jararacussu .C. parapsilosis and C. orthopsilosis emerged as fungal pathogen with significant worldwide prevalence, particularly in causing nosocomial and skin infections. In this study, we aimed to develop molecular assay based on real-time PCR for sensitive and accurate detection of C. parapsilosis and C. orthopsilosis . A pair of primers that specifically target on both of these yeast species was designed and real-time PCR amplification assay was optimized using EvaGreen as the DNA binding dye. The optimized assay could detect and quantify up to 1 pg concentration of C. parapsilosis and C. orthopsilosis DNA with amplification efficiency of 104% and 103%, respectively. Both the designed primers and the quantitative assay will have a great potential as molecular diagnosis tool for early detection of fungal infection caused by either C. parapsilosis or C. orthopsilosis , which merits future clinical study prior to use in diagnosis.Sirenomelia or the “mermaid syndrome” is a rare entity. Malformations of almost every system have been reported in sirenomelia and it is invariably incompatible with survival; most babies are stillborn, or die shortly after birth. Isolated levocardia is an extremely rare condition in which the heart is located in the normal position while abdominal viscera are inverted .We report a case of symelia unipus having situs inversus of abdominal viscera with isolated levocardia, a ventricular septal defect, bilateral genitourinary agenesis and thoracic vertebral defects.[Abstract] Objective To explore the expression of IL-27, Th17 cells and their related cytokines IL- 17 in peripheral blood of patients with allergic rhinitis (allergic rhinitis, AR). Method 18 Cases of allergic rhinitis patients (10 males, 8 females) whose allergen was dust mite were collected from April to June 2012 as the AR group, and 10 cases of healthy volunteers (4 males, 6 females) without allergic diseases were put into the control group. IL-27 and IL-17 levels in serum of peripheral blood of the two groups were detected by ELISA, and the percentage of Th17 cell was detected by flow cytometry. Result IL-27 levels of AR group and control group were (21.69 ± 12.62) pg / ml and (53.10 ± 12.55) pg / ml respectively, and the difference was statistically significant (P <0.01); IL-17 levels of AR group and control group were (672.82±63.45) pg / ml and (576.62±22.81) pg / ml respectively, and the difference was statistically significant (P <0.01); Th17 cell percentage of AR group was 1.76 ± 0.60%, and in the control group it was 0.59 ± 0.17%. The difference between the two groups was statistically significant (P <0. 01). IL-27 was negatively correlated to Th17 cell and IL-17 (r was -0.361 and -0.435 respectively, P <0 05). Conclusion The reduction of IL-27 level in the peripheral blood of patients with allergic rhinitis, the increase of Th17 cells percentage and IL-17 level, as well as the negative correlation of IL-27 with Th17 cell and IL-17 suggest that decline of IL-27 suppression to Th17 cell may play an important role in the pathogenesis of allergic rhinitis.

Control of an Outbreak of Acinetobacter baumannii in Burn Unit in a Tertiary Care Hospital of North India

Acinetobacter infection is increasing in hospitals and now it is considered as a global threat, as it can be easily transmitted and remain viable in the hospital environment for a long time due to its multidrug-resistant status, resistance to desiccation, and tendency to adhere to inanimate surfaces. Outbreaks caused by multidrug-resistant Acinetobacter baumannii (MDRAB) are difficult to control and have substantial morbidity and mortality, especially in vulnerable host. Here we are describing an outbreak of multidrug-resistant Acinetobacter baumannii in burn unit of a tertiary care hospital in India followed by its investigation and infection control measures taken to curtail the outbreak. Outbreak investigation and environmental sampling are the key factors which help in deciding the infection control strategies for control of outbreak. Implementation of contact precautions, hand hygiene, personnel protective equipment, environmental disinfection, isolation of patients, and training of health care workers are effective measures to control the outbreak of MDRAB in burn unit.

Ventilator associated pneumonia in the ICU: microbiological profile

Ventilator associated pneumonia (VAP) is defined as nosocomial pneumonia in patients on mechanical ventilator support (by endotracheal tube or tracheostomy) for >48h during their ICU stay, excluding any infection present or in incubation at the time of ICU admission.1 VAP is estimated to occur in 9-27% of all mechanically ventilated patients, with the highest risk being early in the course of hospitalization.2,3 It is the second most common nosocomial infection in the intensive care unit (ICU) and the most common in mechanically ventilated patients.4,5 The mortality with VAP is considerably high, varying from 24 to 50% and can reach as high as 76% in some specific settings.6

Needle-stick injury among health care workers and its response in a tertiary care hospital.

Needle-stick injuries (NSIs) are a potentially serious threat to health care workers (HCW) due to high risk of transmission of blood-borne pathogens such as HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). We aimed to find the incidence of NSIs amongst different categories of HCWs in our hospital along with associated risk factors for the same. HCWs, who reported to ICTC from January 2011 to December 2013, were included in the study, and a detailed proforma for NSI was filled for each individual. After taking informed consent, all exposed HCWs and source patients were screened for HIV, HBV and HCV infections by rapid screening tests. The HCW were referred to ART centre, and further management was given by ART in-charge.[1]

Epidemiology of cryptococcal meningitis associated with HIV in an Indian hospital.

Cryptococcus neoformans is an emerging pathogen especially in the setting of HIV infected patients with meningitis. The infection usually manifests in patients with impaired cell mediated immunity. Forty six culture positive cases of cryptococcal meningitis were identified over a period of three years from a tertiary care institute in Delhi. The patients were predominantly males (91%) of reproductive age group, mostly residing in and around Delhi. Most significant co-infections were HIV infection in 93% and tuberculosis in 43.5% cases. All forty six strains belonged to Cryptococcus neoformans var grubii, molecular type VN I, mating type α (MAT α). There was 100% susceptibility to amphotericin B and azoles, one isolate was resistant to 5-fluorocytosine (MIC 64 μg/ml). Cerebrospinal fluid in symptomatic HIV patients should be carefully screened for Cryptococcus spp. which should be identified and also typed for epidemiological purposes.