Shalini Malhotra

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.

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.

A Rare Case of Tubercular Breast Abscess in a Young Immunocompetent Non-Lactating Female

Tuberculosis (TB) is a major public health problem in India accounting for one-fourth of the global incident TB cases annually and associated with high morbidity and mortality if not treated adequately. However, breast tuberculosis is a very rare entity with an incidence between 0.1%-3% of all breast diseases, and approximately 4% incidence among breast diseases in TB endemic countries. Here we are reporting a rare case of primary tubercular abscess in the subareolar region of right breast of a young non-lactating female that initially presented with a painful lump and non-specific symptoms. Ultrasound breast suggested breast abscess and diagnosis of tuberculosis was made by FNAC (Fine Needle Aspiration Cytology) and ZN Staining (Ziehl Neelson Staining) of the pus which was confirmed on culture. Patient was started on anti-tubercular therapy and responded well on follow up.

Recent Diagnostic Techniques in Mycology

The frequency of fungal infections, especially of Invasive Fungal Infections (IFIs), has risen dramatically in recent years, and has high morbidity and mortality. Early and accurate diagnosis is important for timely implementation of antifungal therapy and decreasing the unnecessary use of toxic antifungal agents. Conventional microbiological, histological and radiological techniques remain the cornerstone of diagnosis but are insensitive and have a limited impact on clinical decision-making. There is always a need to characterize fungi quickly and accurately which can be done by rapid diagnostic techniques like antigen detection and molecular techniques. This is a brief review of all the microbiological techniques- conventional and recent alternative techniques especially elaborating antigen detection and molecular techniques which are available for diagnosis of fungal infections.

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.

Invasive Rhinocerebral Mycosis: A report of three cases from India

Rhinocerebral mycosis is a rapidly progressive fatal opportunistic infection and is increasingly being recognized these days. Aspergillosis and zygomycosis are predominantly responsible for rhinocerebral mycosis. Here we are presenting three cases of rhinocerebral mycosis- two cases of rhinocerebral mucormycosis and one case of rhinocerebral aspergillosis. Diagnosis is established presumptively from fungal culture of sinus or nasal material and tissue biopsy for histopathological examination. MRI brain was done in all the three cases which showed extension of disease in the cavernous sinus (case 1), orbit and peri-orbital region (case 2) and frontal lobe (case 3). Amphotericin B was initiated in all the cases, while surgical debridement was done in the 3rd case. However two out of three cases were succumbed to their illness after 10-12 days of admission, suggesting high mortality in such cases.

Molecular Methods in Microbiology and their Clinical Application

Conventional microbiology is an inexpensive but protracted diagnostic method and there are certain limitations associated with it. Molecular methods have been increasingly incorporated in laboratories, particularly for the detection and characterization of isolates and for the diagnosis of diseases due to fastidious, slow growing, nonviable or non-cultivable organisms which cannot be detected by conventional culture techniques. The introduction of these techniques and their automation provides new opportunities for the clinical laboratory to affect patient care. These tests provide timely results which are useful for high-quality patient care at a reasonable cost and are associated with improvement in patients care. The use of amplification techniques such as polymerase chain reaction, real-time polymerase chain reaction or nucleic acid sequence-based amplification for micro-organisms detection, genotyping and quantification. Molecular methods are rapid and highly sensitive and specific. This review will focus on various molecular techniques which are performed in clinical microbiology laboratories and their clinical applications and therefore help in management of infectious diseases.

Brain abscess by Candida tropicalis-A rare Case Report from India

Fungal brain abscess is a rare entity especially in an immune competent host. Here we report a rare case of Candida brain abscess in a 19 year old immune competent patient. The diagnosis was made by CT scan of brain and confirmed by microbiological culture. The patient did not respond to surgical intervention and antimicrobial therapy and succumbed to his illness.

Utilization of ashwagandha (Withania somnifera) for development of value added products

Three types of value added products viz. ashwagandha sweet n salty biscuit, ashwagandha churan ball, and ashwagandha beverage were prepared by the incorporation of ashwagandha root powder, ashwagandha leaf powder and ashwagandha root+ leaf powder. Ashwagandha biscuit was ranked higher in acceptability than ashwagandha churan ball and the beverage was liked the least. The products prepared by the incorporation of ashwagandha leaf powder and ashwagandha root+ leaf powder were not acceptable in comparison to the products prepared by the incorporation of Ashwagandha root powder. This might be due to the bitterness of leaves. The changes in the sensory attributes of the products differed slightly during 30 storage period.

Fusarial Sinusitis from Immunocompromised Child: A Rare Case Report from New Delhi, India

Fusarium causes a broad spectrum of human diseases which can be superficial, locally invasive or disseminated. In immuno-competent host, it causes allergic sinusitis or chronic non-invasive sinusitis while in immuno-compromised patients it causes invasive sinusitis. In this paper, the authors present a case of a 15-year-old boy who was admitted in the pediatric ward of PGIMER Dr. RML hospital, New Delhi, India with history of spontaneous erosion of dorsum of nose. Local examination showed complete erosion of dorsum of nose. The nasal debris was then sent to the Microbiology department for fungal culture and microscopy. On microscopic examination, branched septate hyphae were seen. The culture on Sabouraud’s Dextrose Agar (SDA) showed cottony white growth initially after 1 week of incubation and this growth later showed grayish pigmentation. The lactophenol cotton blue (LPCB) mount of this growth showed septate hyphae along with typical hyaline, multi-septate, curved sickle shaped macroconidia. A tentative diagnosis of fungal sinusitis by Fusarium Spp. was done in this case.