Shalini Dewan Duggal

HIV and Malnutrition: Effects on Immune System

HIV or human immunodeficiency virus infection has assumed worldwide proportions and importance in just a span of 25 years. Continuous research is being done in many parts of the world regarding its treatment and vaccine development, and a lot of money has flown into this. However, fully understanding the mechanisms of immune depletion has still not been possible. The focus has also been on improving the quality of life of people living with HIV/AIDS through education, counselling, and nutritional support. Malnutrition further reduces the capacity of the body to fight this infection by compromising various immune parameters. Knowledge of essential components of nutrition and incorporating them in the management goes a long way in improving quality of life and better survival in HIV-infected patients.

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.

Comparison of an Automated System with Conventional Identification and Antimicrobial Susceptibility Testing

The present study was designed to compare a fully automated identification/antibiotic susceptibility testing (AST) system BD Phoenix (BD) for its efficacy in rapid and accurate identification and AST with conventional manual methods and to determine if the errors reported in AST, such as the (very major errors) VME (false susceptibility), (major errors) ME (false resistance), and (minor errors) MiE (intermediate category interpretation) were within the range certified by FDA. Identification and antimicrobial susceptibility test results of eighty-five clinical isolates including both gram-positive and negative were compared on Phoenix considering the results obtained from conventional manual methods of identification and disc diffusion testing of antibiotics as standards for comparison. Phoenix performed favorably well. There was 100% concordance in identification for gram-negative isolates and 94.83% for gram-positive isolates. In seven cases, Phoenix proved better than conventional identification. For antibiotic results, categorical agreement was 98.02% for gram-positive and 95.7% for gram-negative isolates. VME was 0.33%, ME 0.66%, MiE 0.99% for gram-positive isolates and 1.23% VME, 1.23% ME, and 1.85% MiE for gram-negative isolates. Therefore, this automated system can be used as a tool to facilitate early identification and susceptibility pattern of aerobic bacteria in routine microbiology laboratories.

Acanthamoeba keratitis with Curvularia co-infection.

We report a case of Acanthamoeba keratitis with Curvularia co-infection. Acanthamoeba and fungal co-infection have been uncommonly reported in literature, worldwide. A classical history with a strong clinical suspicion and experienced laboratory personnel with systematic examination of corneal scrapings for bacterial, viral, parasitic and fungal causes are imperative for accurate diagnosis. Early diagnosis of Acanthamoeba keratitis or fungal infection followed by aggressive and appropriate treatment with effective agents is critical for the retention of good vision. Acanthamoeba keratitis is difficult to diagnose and, despite improvement in treatment options, may culminate in prolonged morbidity and significant loss of visual acuity. This case emphasizes the important role played by clinical microbiologists in making prompt diagnosis which can ultimately reduce visual morbidity.

Candida krusei fungemia in 7 neonates: Clonality tracked to an infusate

Fungemia is considered a major cause of neonatal morbidity and mortality. Candida krusei is an infrequent isolate among healthy hosts, but is a pathogen of concern among immunocompromised patients, in whom it can cause fungemia, endopthalmitis, arthritis, and endocarditis.1 It is difficult to treat owing to intrinsic fluconazole resistance and variable susceptibility to flucytosine and amphotericin B.2 We report an outbreak of C krusei fungemia in the neonatal Intensive care unit (ICU) of our hospital over a short period of 2 weeks. In May 2013, blood samples from 7 neonates were received for microbiological cultures. These patients had developed signs of infection, including lethargy, feeding intolerance, sclerema, hypotension, increased oxygen requirement, and increased need for ventilatory support, within a span of 3-4 days. Fungal culture grew yeast-like colonies identified as C krusei, based on a negative germ tube test, characteristic morphology on corn meal agar, and results of the sugar assimilation test, which was positive for dextrose but negative for other sugars. Case definition was established for patients who were likely to have been exposed during this time period with similar risk factors and location. The hospital authorities were alerted. Cultures were obtained of potential point source contaminants in the environment, including intravenous (IV) medications administered to patients, and processed likewise. Antifungal susceptibility patterns were reviewed, followed by molecular analysis to establish the relatedness of suspected organisms. All isolates were susceptible to amphotericin B (minimum inhibitory concentration [MIC], 0.25 mg/mL), caspofungin (MIC, 1 mg/mL), micafungin (MIC, 0.125 mg/mL), and anidulafungin (MIC, 0.125 mg/mL), but resistant to fluconazole (MIC, 64 mg/mL). Antifungal therapy was started with conventional amphotericin B 1 mg/kg/day IV for 2 weeks. Infection control surveillance cultures from a neonatal intensive care unit revealed growth of C krusei from a sealed bottle of multielectrolyte dextrose solution of the batch used in the unit. No growth of C krusei was observed from other environmental samples or from patients in other pediatric units of the hospital. Relatedness among the 7 clinical isolates of C krusei and the isolate from pediatric multielectrolyte dextrose solution was established by similar growth, antifungal susceptibility, and molecular profiles in random amplified polymorphic DNA analysis (Fig 1) using M-13 primer (50-GAGGGTGGCGGTCT-30) demonstrating a clonal origin. The use of this solution was discontinued

Staphylococcal bullous impetigo in a neonate.

An otherwise healthy, full-term neonate presented at day 15 of life to the pediatric emergency with generalized papulo-pustular rash for 2 d. This was finally diagnosed as bullous impetigo caused by Staphylococcus aureus (S. aureus). The skin lesions decreased significantly after starting antibiotic therapy and drainage of blister fluid. There was no recurrence of the lesions on follow-up. This case of generalized pustular eruption due to S. aureus in a neonate is reported, as it poses a diagnostic dilemma and can have serious consequences if left untreated.

Recurring Events of Candida krusei Septicaemia: First Report from an ICU

Resurgence of nonalbicans Candida spp. was observed thrice at the same location in our hospital over a period of four years. In two of these outbreaks it was identified up to the molecular level as Candida krusei. This fungus was traced to some environmental source in all three episodes. Prompt infection control measures were initiated which helped to control the outbreak every time. To the best of our knowledge, this is the first series of recurring Candida krusei infections at the same site in a hospital with successful control of each episode.

Safe transportation of biomedical waste in a health care institution

Introduction: The chances of health care waste (Biomedical waste) coming in contact with the health care workers, patients, visitors, sanitary workers, waste handlers, public, rag pickers and animals during transportation are high. Materials and Methods: The study was conducted over a period of seven months (April 2013-October 2013) in a 500-bedded hospital where the average quantum of biomedical waste is 0.8 kg/bed/day. The issues related to transportation of health care waste from 39 generation sites to the health care waste storage site inside the hospital (intramural transfer) were addressed and analysed in a predesigned proforma. Results: The biomedical waste management team inspected the generation sites in the hospital on a daily basis and conformance to the procedures was checked. It was found that waste was collected at scheduled timings in 99.6% occasions; however, compliance to wearing personal protective equipment (PPE) was poor and ranged from 1.22−1.84%. Conclusion: Transportation of health care waste is a crucial step in its management. Regular training program for all the sections of health care workers with special emphasis on waste handlers is needed.

Staphylococcus aureus bacteremia: targeting the source.

Abstract Bacteremia due to Staphylococcus aureus is one of the major causes of morbidity and mortality in India, but studies targeting the source of Staphylococcus aureus bacteremia are lacking. S. aureus has a vivid armamentarium consisting of toxins, adhesins, and other virulence factors by virtue of which it can cause varied types of infections, sometimes of a serious nature. This review highlights the possible causes of S. aureus bacteremia, and discusses the necessity of tracing its source and eliminating it with proper antibiotic therapy to avoid recurrences or relapses.

Nocardial Infections: An Under-Diagnosed Malady of Immunocompromised Hosts

Nocardial Infections: An Under-Diagnosed Malady of Immunocompromised Hostse Nocardia spp. is emerging as important cause of infections especially in the immunosuppressed patients. Infection is serious with high morbidity and mortality; treatment can be prolonged and difficult with marked tendency to recur. However, a high index of clinical suspicion is required for diagnosis. With growing population of the immunocompromised, it can be assumed that many of these infections go unreported and are largely under-diagnosed.