Renu Bansal

The 2011 outbreak of dengue virus infection in Malwa region of Punjab, India-an evaluation of various diagnostic tests

Abstract Objective To compare the efficacy of rapid immunochromatographic test (ICT) and ELISA for detection of dengue specific parameters (NS1 antigen and IgM antibodies) and the association of these parameters with thrombocytopenia. Methods A total of 1787 serum samples were obtained from the same number of clinically suspected cases of dengue during an outbreak (2011) of dengue in the Malwa region of Punjab. All the samples were subjected to rapid ICT, dengue early ELISA and dengue IgM-capture ELISA for detection of NS1 antigen and IgM antibodies. Platelet counts of all the cases positive for dengue infection and 150 cases negative for dengue parameters (control group) were recorded. Resutls Rapid ICT for NS1 antigen detection showed same specificity (100%) but lower sensitivity (85.81%) than the dengue early ELISA, while it was 100% and 94.10% respectively for IgM antibody detection. The difference in the platelet counts of cases positive and negative for dengue specific parameters was stastically insignificant (standard error of proportions=0.017, Z value=0.84, P value=0.2). Conclusions The confirmation of serological diagnosis of dengue should always be based on ELISA test and ICT and/or thrombocytopenia should not be used as a stand-alone test.

Water Borne Hepatitis A and Hepatitis E in Malwa Region of Punjab, India

INTRODUCTION Hepatitis-A virus infection (HAV) and Hepatitis E virus infection (HEV) are faecally contaminated water borne infection of great public interest in developing countries. HAV has a world-wide /dablestribution and affects infant and young children in developing countries and its epidemics are not very common. HEV is restricted to tropical countries and affects older children and young adults and its epidemics are common. Studies suggested that HEV is etiologically responsible for 10%-95% of admitted cases of hepatitis. Exposure rates over a period of time are different in different parts of the country and in different socio-economic groups. Aim of the study 1. To study the prevalence of HAV and HEV in the outbreak of hepatitis in certain areas of Malwa region of Punjab, India. 2. To determine the age specific prevalence rates of HAV and HEV. 3. To determine any change in the epidemiology of these infections. MATERIAL AND METHODS This study was conducted in the Department of Microbiology in GGMC and Hospital Faridkot, A leading Tertiary care hospital and the major referral centre of malwa region of Punjab,India. Collection and Serological Tests: 1.Venous blood samples of patients of acute hepatitis were taken. 2.Relavent information regarding their Age, Sex Education, Socio-economic status, personal and community hygiene were recorded. All of the sera were screened for IgM Antibody to HEV and HAV using IgM capture ELISA Kit (ASIA-LION Biotechnology for HEV and GENERAL BIOLOGICAL CORPORATION for HAV ) in accordance with the manufacturers instructions. Result and Conclusion : 1.The outbreak was due to hepatitis A &E virus(HEV predominating resulting from fecal contamination of drinking water). 2.Hepatitis E is more widely prevalent 3.There is a change in the epidemiology of HAV so,more cases are seen in age group of more than 20 years.

Rapid Detection of Mycobacterium tuberculosis in Sputum Samples by Cepheid Xpert Assay: A Clinical Study.

BACKGROUND AND OBJECTIVE Tuberculosis (TB) is one of the commonest opportunistic infection and the leading cause of death in HIV patients in developing countries. HIV infection is a well recognised risk factor for both activation of initial infection and reactivation of latent infection. This study was done to find out the co-prevalence and the trend of HIV infection among tuberculosis patients and to determine the prevalence of MDR Tuberculosis in HIV positive patients using Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA, United States). MATERIALS AND METHODS The sputum samples are received from five districts of Punjab. Sputum samples of the patients with symptoms suggestive of pulmonary tuberculosis including both new cases and on treatment are received from the various district and civil hospitals of five districts. Sputum specimen was processed for TB detection by Cartridge Based Nucleic Acid Amplification testing (CB-NAAT) using Xpert MTB/RiF assay technology. RESULTS The study period is from October 2013 to September 2014. A total of 907 patients with symptoms suggestive of pulmonary tuberculosis including both new cases and on treatment. Out of these patients 733 were reported MTB detected. Out of these 907 patients 29 were reported HIV positive and out of 733 patients 19(2.5%) were reported positive for (HIV +TUBERCULOSIS). Of these 19 cases 16(84.21%) cases were sensitive to rifampicin (RIF) and 3(15.78%) cases were showing resistance to rifampicin (RIF) Drug. CONCLUSION Co-existence of HIV and tuberculosis is high and there is high Prevalence of MDR tuberculosis in HIV patients.

Risk factors and genotypes of HCV infected patients attending tertiary care hospital in North India.

also lack risk perception due to unsafe injections. A study by Chakravarti et al.,[1] reported blood transfusion to be the major risk factor (54.8%), which was observed in 30.2% of our study. Although, mandatory screening of blood for HCV was introduced in 2002, it seems that transmission of HCV through unscreened blood still continues. History of dental procedures, which was observed in 22.2% of our study, corroborates the fi ndings of Chakravarti et al.[1] This could be because many dental procedures are performed by untrained individuals using unsterilised equipment.

Disease dynamics and surveillance of malaria in Malwa region of Punjab and evaluation of RDT test.

Aim: Malaria remains an enormous public health problem. Regular and ongoing surveillance to detect changes in its trends to initiate the control measures is the need of the hour. The present study was undertaken to provide the malaria transmission dynamics using surveillance indicators through active and passive surveillance in district Faridkot. Usefulness of rapid malaria diagnostic test was also evaluated. Methodology: This retrospective study extended over a period of two years (2010-2011). Thick and thin blood smears were prepared from suspected cases of malaria complaining of fever and headache for the last three days (i) of 2 CHC’s, 8 PHC’s and 68 sub centers as a part of active surveillance and (ii) those who visited GGS Medical College & Hospital and civil hospital Faridkot as a part of passive surveillance. Out of all the samples collected during the passive surveillance 995 samples collected at GGS Medical College and Hospital, Faridkot were also subjected to rapid diagnostic test (OptiMAL). Results: The annual blood examination rate (ABER) was 9.0 and 9.7 in 2010 and 2011 respectively. Annual parasite incidence (API) recorded was < 2 (0.5) in both the years and slide positive rate (SPR) was 0.5 and 0.05 in the two respective years of study. Significant gap in the rate of case detection of active and passive surveillance systems was observed with predominance of passive surveillance. More than 96% of cases were of P. vivax. Research Article British Microbiology Research Journal, 3(3): 339-345, 2013 340 RDT’s showed an excellent correlation with conventional microscopy. Conclusion: Malaria (P. vivax) is a persistent problem in the Malwa region with variation in its transmission dynamics with in the year. P. vivax is the main species of malarial parasite in the Faridkot district with occasional cases of falciparum malaria. Prevention strategy should be targeted towards on the spot diagnosis by using RDT and hence prompt treatment. It could help to prevent spread of drug resistance and complicated malaria.

Antimicrobial resistance profile of Methicillin-resistant Staphylococcus aureus colonizing the anterior nares of health-care workers and outpatients attending the remotely located tertiary care hospital of North India.

Introduction: Resistance to antimicrobial agents is a major concern worldwide and is exemplified by the global spread of the Methicillin resistant Staphylococcus aureus (MRSA). Health care workers (HCWs) and asymptomatically colonized patients are important sources of nosocomial MRSA infections. Aims and Objectives: To determine the prevalence of MRSA colonisation, two hundred HCWs and 200 consecutive outpatients attending our tertiary care hospital were studied. Material and Methods: Two sterile pre-moistened cotton tipped swabs were used to collect specimens from their anterior nares. These were inoculated immediately on Blood agar with oxacillin, Mannitol salt agar with oxacillin and CHROM agar. Resistance to cefoxitin was confirmed by PCR by demonstration of mecA gene. Antibiotic susceptibility was determined by Kirby Bauers disc diffusion method and MIC of vancomycin by using broth dilution and Vitek-2 Compact system. Results: The nasal carriage of MRSA among HCWs was found to be 7.5% and in outpatients 3%. All strains of MRSA from HCWs and outpatients grew on three selective media and mecA gene amplified in all of them. All the isolated strains of MRSA showed high degree of resistance to co-trimoxazole (93.3%), ciprofloxacin (80%) and erythromycin (66.66%). However, there was 100% susceptiability to vancomycin, teicoplanin, linezolid and Rifampicin. Conclusion: Although a direct casual relationship could not be established, it could be assumed that the transmission from colonised health care worker is responsible atleast in part for MRSA infection among patients. Therefore emphasis should be laid on strict implementation of standard infection control practices which would help in minimizing the carriage and transmission of MRSA in the hospital.

Methicillin resistant Staphylococcus aureus (MRSA) in Malwa region of Punjab (North-West India).

Sir, Methicillin resistant Staphylococcus aureus (MRSA) has emerged as a dangerous pathogen of hospital acquired infection and is also spreading in the community1,2. We report here data on this infection from a teaching hospital located in North-West India. During 2012-2013, a total of 248 Staphylococcus aureus isolates obtained from various clinical specimens like pus, blood, urine, body fluids, catheter tips etc. Of the patients visiting Guru Gobind Singh Medical College (GGSMC) and Hospital, Faridkot, Punjab, India, were studied. Of these, 161 (64.9%) were detected as MRSA and 87 (35%) as methicillin sensitive Staphylococcus aureus (MSSA) by observing their resistance to cefoxitin (30 µg) disc3. Further confirmation of methicillin resistance was done by demonstration of mecA gene by PCR4. Overall, MRSA was found in 64.9 per cent (161/248) samples which was higher than the prevalence reported in Indian Network of Surveillance of Antimicrobial Resistance (INSAR) study (41%)1 but was in the range (22 to 68%) observed by various centres participated in the study1. The MRSA increased from 60.5 per cent (92/152) in 2012 to 71.8 per cent (69/96) in 2013, but the difference was not significant. Similar increase has also been reported by six of the 15 tertiary care centres during the two years period (January 2008 to December 2009) of the surveillance1. In our study, the isolation rates of MRSA from non-ICU inpatients (50% in 2012; 69.6% in 2013) were higher than that of outpatients (29.3% in 2012; 18.8% in 2013) and ICU patients (20.7% in 2012; 13% in 2013). This was in contrast to the INSAR study where the isolation rates of MRSA were maximum from ICU followed by non-ICU inpatients and outpatients1. The study of S. aureus isolates from various clinical specimens at our centre showed that maximum isolates were from skin and soft tissue infections followed by blood stream infections and respiratory infections. Susceptibility to various antibiotics is shown in the Table. Similar to the various studies of the INSAR surveillance1, we observed that MRSA isolates were more resistant to antimicrobial agents in comparison to MSSA. However, this difference was not significant for erythromycin, clindamycin, gentamicin and ciprofloxacin. However, for ampicillin and co-trimoxazole the difference was found to be significant (P<0.001). All S. aureus isolates were sensitive to vancomycin and linezolid. Table Antibiotic susceptibility results of 248 isolates of methicillin resistant (n=161) and methicillin sensitive (n=87) Staphylococcus aureus (2012-2013) Thus, our results showed a high and increasing isolation rates of MRSA in the Malwa region of Punjab. This underscores the need of judicious use of antibiotics and strengthening of the implementation of infection control measures. Although the MRSA and MSSA isolates in our study showed sensitivity to glycopeptides and linezolid, but their use should be cautiously preserved for MRSA isolates only as reports of reduced susceptibility to vancomycin [vancomycin intermediate Staphylococcus aureus (VISA) and vancomycin resistant Staphylococcus aureus (VRSA)] have already been reported5.

Granulicatella adiacens : An unusual isolate from urethral discharge.

Around 75.6% of our samples were positive within 24 h with the use of ABCS while 65.4% samples detected by CBCS were positive after the second subculture and around 12.6% samples were positive after the third subculture. The first report was dispatched in 93 h and 36 min using CBCS and by ABCS within 52 h and 48 min. A provisional report was provided on the basis of Gram-staining of positive flagged bottles detected by ABCS. On an average initial provisional report was available by 28 h and 48 min, reducing the time of reporting by 64 h and 48 min. With the use of ABCS final reporting time was reduced by 40 h and 48 min (i.e., by ~ 2 days).

Onychomycosis of toenails caused by Syncephalastrum racemosum: A rare non-dermatophyte mould.

Apropos, an informative report – ‘A rare case of subcutaneous mucormycosis due to Syncephalastrum racemosum: Case report and review of literature’ which was published in the fourth issue of 2014 of your journal,[1] we wish to submit a case report of onychomycosis caused by this uncommon but ubiquitous saprophytic fungus of low human pathogenicity. Only a few cases of onychomycosis caused by S. racemosum have been documented so far.[2,3]

Hepatitis C Virus (HCV) Infection among Seronegative Patients undergoing Haemodialysis in a Remotely Located Tertiary Care Hospital of Northern India: Value of HCV-RNA and Genotypes.

BACKGROUND Haemodialysis (HD) patients are at an increased risk of Hepatitis C virus (HCV) infection, which is significantly associated with increased morbidity and mortality. AIM The aim of this study was to find the prevalence of HCV infection in anti-HCV antibody negative haemodialysis patients by Real-time PCR (RT-PCR) and value of HCV-RNA among seronegative patients undergoing haemodialysis in a remotely located tertiary care hospital. MATERIALS AND METHODS A total of 100 chronic renal failure patients on haemodialysis were studied. All the patients were screened for anti-HCV antibodies by ELISA test and for HCV-RNA by RT-PCR. RESULTS The overall prevalence of HCV infection was 32%. Antibody positivity was 30% and HCV-RNA by RT-PCR was detected in 20%. HCV-RNA in seronegative patients was detected in 2.8%. CONCLUSION Serological assays (30%) are quite reliable for detecting HCV infection in patients undergoing haemodialysis in our tertiary care hospital. Only a small proportion of them (2.8%) require the documentation of viral genome for current infection.