Ke Vandana

Molecular characterization of clinical Burkholderia pseudomallei isolates from India.

Multilocus sequence typing of seven isolates of Burkholderia pseudomallei from India showed considerable diversity, with six different sequence types. Possible dissemination of melioidosis by historical trading routes is supported by links to strains from Southeast Asia, China, and Africa and the presence of the Burkholderia mallei allele of the bimA gene.

A child with Erysipelothrix arthritis-beware of the little known.

Erysipelothrix rhusiopathiae is an established animal pathogen while the zoonotic infections in humans are rarely reported. Infections occur after exposure to animals or animal products that are mostly occupational in adults. Here we report in a child for the first time septic arthritis and osteomyelitis without an identifiable risk factor. A 5-year-old male child was admitted with pain in the left hip joint and inability to bear weight on the limb. Clinical examination followed by radiological and magnetic resonance imaging was suggestive of septic arthritis. Erysipelothrix rhusiopathiae grew from peroperative joint specimen. The infection was resolved following arthrotomy, joint lavage and antibiotic therapy.

Prevalence of Measles, Mumps, Rubella, and Varicella Susceptibility Among Health Science Students in a University in India

BACKGROUND Health science students (HSS) are at increased risk of contracting and transmitting viral diseases such as measles, mumps, rubella, and varicella (chickenpox). This study was undertaken to determine the prevalence of susceptibility of HSS to these infections. METHODS Using a cross-sectional design, 790 HSS of Manipal University, Manipal, India, answered a questionnaire and provided a blood sample which was tested for specific IgG antibodies to measles, mumps, rubella and varicella by ELISA (Enzygnost(®)). RESULTS The study group was comprised of medical (53.9%), nursing (16.6%), and allied health (29.5%) students. Among the overall group (n = 790), the prevalence of serological susceptibility to measles, mumps, rubella, and varicella were 9.5%, 32.0%, 16.6%, and 25.8%, respectively. Among the subgroup of vaccinated subjects, susceptibility to measles, mumps, rubella, and varicella were 7.9%, 34.7%, 10.7%, and 35.2%, respectively. CONCLUSION HSS susceptible to measles, mumps, rubella, and/or varicella are at risk of acquiring these diseases during their training period. In addition, they may be a potential source for nosocomial transmission posing a risk to immunocompromised patients. Hence, in the Indian setting, HSS should be immunized against measles, mumps, rubella, and varicella at the time of joining the medical school.

Unravelling the Molecular Epidemiology and Genetic Diversity among Burkholderia pseudomallei Isolates from South India Using Multi-Locus Sequence Typing.

There is a slow but steady rise in the case detection rates of melioidosis from various parts of the Indian sub-continent in the past two decades. However, the epidemiology of the disease in India and the surrounding South Asian countries remains far from well elucidated. Multi-locus sequence typing (MLST) is a useful epidemiological tool to study the genetic relatedness of bacterial isolates both with-in and across the countries. With this background, we studied the molecular epidemiology of 32 Burkholderia pseudomallei isolates (31 clinical and 1 soil isolate) obtained during 2006–2015 from various parts of south India using multi-locus sequencing typing and analysis. Of the 32 isolates included in the analysis, 30 (93.7%) had novel allelic profiles that were not reported previously. Sequence type (ST) 1368 (n = 15, 46.8%) with allelic profile (1, 4, 6, 4, 1, 1, 3) was the most common genotype observed. We did not observe a genotypic association of STs with geographical location, type of infection and year of isolation in the present study. Measure of genetic differentiation (FST) between Indian and the rest of world isolates was 0.14413. Occurrence of the same ST across three adjacent states of south India suggest the dispersion of B.pseudomallei across the south western coastal part of India with limited geographical clustering. However, majority of the STs reported from the present study remained as “outliers” on the eBURST “Population snapshot”, suggesting the genetic diversity of Indian isolates from the Australasian and Southeast Asian isolates.

Seroprevalence of Burkholderia pseudomallei among Adults in Coastal Areas in Southwestern India.

Background Although melioidosis, is an important disease in many Southeast Asian countries and Australia, there is limited data on its prevalence and disease burden in India. However, an increase in case reports of melioidosis in recent years indicates its endemicity in India. Aims and methods A population-based cross-sectional seroprevalence study was undertaken to determine the seroprevalence of B. pseudomallei by indirect haemagglutination assay and to investigate the associated risk determinants. Subjects were 711 adults aged 18 to 65 years residing in Udupi district, located in south-western coast of India. Key results Overall, 29% of the study subjects were seropositive (titer ≥20). Females were twice as likely to be seropositive compared to males. Rates of seroprevalence were similar in farmers and non-farmers. Besides gardening, other factors including socio-demographic, occupational and environmental factors did not show any relationship with seropositive status. Major conclusions There is a serological evidence of exposure to B. pseudomallei among adults in India. While the bacterium inhabits soil, exposure to the agent is not limited to farmers. Non-occupational exposure might play an important role in eliciting antibody response to the bacterium and may also be an important factor in disease causation.

Time to positivity of blood cultures in neonates.

Blood culture reports in neonatal sepsis aid physician in either optimizing therapy or discontinuing antibiotics. We determined the time taken for neonatal blood cultures to become positive using the aerobic BacT/Alert system. Of 944 blood cultures from 816 neonates, 139 (14.7%) were positive. Growth of all definitive bacteria, 95% of possible bacteria and 84% of fungi were detected within 48 hours of incubation.

Colistin-resistant Acinetobacter baumannii ventilator-associated pneumonia in a tertiary care hospital: an evolving threat

Ventilator-associated pneumonia (VAP) is the most frequently occurring nosocomial infection in mechanically ventilated patients. Acinetobacter infection has emerged as a frequent cause of VAP in recent decades and is characterized by rapid development of resistance to most of the antibiotics that would be clinically useful. Acinetobacter VAP (AVAP) poses grave implications in terms of high mortality and increased healthcare costs worldwide. Therefore, the present study was undertaken with the aim of studying the risk factors and outcome of patients developing AVAP. We performed a caseecontrol study for a period of one year (April 2012 to March 2013) in the medical intensive care unit (ICU) of a tertiary care hospital in south India. Cases were patients exposed to a ventilator who developed AVAP with a clinical pulmonary infection score (CPIS) 6. The isolates were identified as Acinetobacter baumannii by Vitek MS system (bioMérieux, Nürtingen, Germany). Ageand gender-matched patients exposed to a ventilator in the same ICU setting who did not develop VAP (CPIS <6) were taken as controls in the ratio of 1:2. Risk factors for developing AVAP such as prolonged ICU stay and duration of ventilation, antibiotic exposure, receipt of blood products, invasive procedures besides intubation and surgery were analysed. Samples from the AVAP patients’ humidifier or heat and moisture exchanger (HME) filter were sent for microbiological testing to find the source of acinetobacter infection. Institutional ethical clearance was obtained prior to carrying out the study. Informed consent was obtained from legally accepted representatives of the patients and details of the patients were kept confidential by giving them a coded identity. Statistical analysis was carried out using SPSS version 16. In all, 96 patients were included in our study with 32 cases and 64 controls. Mean age for the cases was 52.2 years and for the controls was 51.7 years. Median duration of ICU stay (cases: 21 days; controls: nine days) and mechanical ventilation (cases: 14 days; controls: five days) was significantly higher for

Pulmonary melioidosis in febrile neutropenia: the rare and deadly duet.

Summary We present the first two fulminant cases of pulmonary melioidosis in febrile neutropenic patients with acute and varied presentations seen in our institution and their fatal outcome. A high index of suspicion coupled with microbiological confirmation can facilitate the administration of the appropriate therapy in cases of melioidosis that differ from other bacterial infections in terms of presentation and the response to antimicrobials.

Lower genital tract infections during pregnancy and adverse pregnancy outcomes: a hospital based observational cohort study

Background Maternal lower genital tract during pregnancy is a complex niche of microbes that normally inhabit or cause infections in few instances. Association of various microbial flora and adverse pregnancy outcomes is being increasingly explored. The study was aimed to determine the prevalence of lower genital tract infections (LGTI) among pregnant women and to determine the common etiologies of LGTI and their association with adverse pregnancy outcomes, Pre term birth (PTB) and Low birth weight (LBW).

Performance evaluation of Active Melioidosis Detect-Lateral Flow Assay (AMD-LFA) for diagnosis of melioidosis in endemic settings with limited resources

Melioidosis is a fatal infection caused by the soil saprophyte Burkholderia pseudomallei. Early diagnosis and befitting medical management can significantly influence the clinical outcomes among patients with melioidosis. Witnessing an annual increment in the number of melioidosis cases, over the past few years, mainly from the developing tropical nations, the present study was undertaken to evaluate the diagnostic utility of Active Melioidosis DetectTMLateralFlow Assay (AMD-LFA), in comparison with enrichment culture and PCR. A total of 206clinical specimens obtained from 175 patients with clinical suspicion of melioidosis were considered for the evaluation. Positivity for B.pseudomallei using enrichment culture, PCR and AMD-LFA were observed among 63 (30.5%), 55 (26.6%) and 63 (30.5%) specimens respectively. The AMD-LFA failed to detect melioidosis from 9 culture-confirmed cases (6 whole blood specimens, 2 pus samples, and one synovial fluid). Further the test gave faint bands from 9 urine samples which were negative by culture and PCR. AMD-LFA demonstrated a sensitivity, specificity, of 85.71%(CI:74.61% to 93.25%) and 93.62% (CI:88.23% to 97.04%), with positive predictive value of 85.71% (CI: 75.98% to 91.92%) and negative predictive value of 93.62% (CI:88.89% to 96.42%). The test needs further evaluation in view of the faint bands from negative urine samples, for incorporating the test as a point of care assay.In view of its rapidity and ease of testing AMD-LFA might be useful in early diagnosis of melioidosis at resource constraint settings.