Vinay Khanna

Evaluation of central venous catheter associated blood stream infections: a microbiological observational study.

There are substantial morbidity and mortality associated with vascular catheter use among crictically ill patients. The attributable mortality is 10% to 25% which is associated with bacteremia among those who are hospitalized. This study was undertaken to identify catheter related blood stream infections, to isolate pathogenic microorganisms present in intravascular catheter related local infections, exit site infections, and to determine the predisposing factors for the development of such infections and antibiotic sensitivity pattern of the isolated organisms in tertiary care hospital.

Primary Amoebic Meningoencephalitis in an Infant due to Naegleria fowleri

Primary amoebic meningoencephalitis (PAM) caused by free-living amebae Naegleria fowleri is a rare and fatal condition. A fatal case of primary amoebic meningoencephalitis was diagnosed in a 5-month-old infant who presented with the history of decrease breast feeding, fever, vomiting, and abnormal body movements. Trophozoites of Naegleria fowleri were detected in the direct microscopic examination of CSF and infant was put on amphotericin B and ceftazidime. Patient condition deteriorated, and he was discharged against medical advice and subsequently expired. We also reviewed previously reported 8 Indian cases of primary amoebic meningoencephalitis (PAM) and observed that for the last 5 years, none of the patients responded to amphotericin B. Has an era of amphotericin B-resistant Naegleria fowleri been emerged? Management strategy of PAM needs to be reviewed further.

Acanthamoeba meningoencephalitis in immunocompetent: A case report and review of literature

A 30-year-old manual laborer from Karnataka, India presented with intermittent low grade fever and diffuse headache for 1 month. On examination, patient had enlarged supraclavicular and cervical lymph nodes. Patient had positive Kernig′s sign and neck stiffness. Motor, sensory and cranial nerve examinations were within the normal limits. Abdominal, cardiovascular and chest examination did not yield any positive findings. Contrast enhanced computed tomography head was normal. Patient was suspected to have extrapulmonary tuberculosis. Patient was started on antitubercular drugs. Diagnostic lumbar puncture was performed. Wet mount and Giemsa smear preparation of cerebrospinal fluid (CSF) showed trophozoites suggestive of Acanthamoeba. CSF was cultured onto non-nutrient agar with an overlay of Escherichia coli. Wet mount made from the culture media yielded cysts and trophozoites of Acanthamoeba spp. Patient was diagnosed with Acanthamoeba meningitis and was started on specific therapy with Rifampicin 600 mg once a day, Cotrimoxazole 960 mg twice-a-day and Fluconazole 400 mg once daily for 2 weeks. Patient had a complete recovery and was discharged from the hospital.

Modified Negative Staining of Heine for Fast and Inexpensive Screening of Cryptosporidium, Cyclospora, and Cystoisospora spp.

Negative staining technique of Heine is an easy, inexpensive, and rapid way of screening for coccidian parasites of the intestinal tract. But its use as a routine technique for screening of Cryptosporidium, Cyclospora, and Cystoisospora is restricted due to its sensitivity being lower than the gold standard method of modified Ziehl-Neelsen staining. This paper emphasises the modification of original Heine staining technique which has been attempted in order to increase the sensitivity and detection of oocysts of Cryptosporidium, Cyclospora, and Cystoisospora. Modified Heine staining technique using malachite green is a practical, safe, and sensitive method of detecting oocysts in stool specimens. While the modified Ziehl-Neelsen staining technique is still considered the gold standard for the detection of Cryptosporidium spp., modified negative staining technique of Heine using malachite green stain should be considered as the screening technique of first choice.

Primary Hydatid Cyst of the Kidney and Ureter with Hydatiduria in a Laboratory Worker: A Case Report

Hydatid disease is frequent in endemic regions and sheep farming areas. Most common localization of hydatid cyst occurs in liver followed by lungs. Renal hydatid cyst constitutes about 2–4% of all locations. We report a case of left renal hydatid from a laboratory technician admitted in a tertiary care hospital. There were few cases of renal hydatid disease reported in India among general population but to the best of our knowledge never reported from laboratory worker. The possibility of laboratory-acquired infection cannot be ruled out in this case due to lack of precautionary measures and containment facilities in resource-constrained setting.

Identification and Preservation of Intestinal Parasites Using Methylene Blue-Glycerol Mount: A New Approach to Stool Microscopy

We have tried a new approach to routine stool microscopy by using a combination of methylene blue and glycerol in wet mount preparation of fresh faecal samples for the demonstration of medically important intestinal parasites. This combination was evaluated for finding differences in the details and clarity of morphology and internal structures of parasites under low- and high-power microscopy as compared to iodine and saline mount. It was further evaluated to estimate the time taken by methylene blue-glycerol mount to dry up as compared to iodine and saline wet mount.

Renal fungal bezoar owing to Geotrichum candidum

Geotrichum candidum is yeast like fungi that cause infections in immunocompromised patients. We report a case of renal fungal ball with Geotrichum candidum in a 27 yr. old women post-partum. This case to our knowledge is the first case of renal fungal bezoar due to Geotrichum candidum reported in India.

An Unusual Case of Echinostomiasis in a Retropositive Patient: A Case Report

This report describes an unusual case of echinostomiasis in a retropositive patient with swelling, pain, and purulent discharge over back and right scapular region for 10 days. Stool examination revealed the presence of eggs of hookworm and echinostome. Diagnosis is challenging due to few characteristic features of eggs of echinostomes. They usually infect birds and mammals, and only limited species are implicated in the causation of human disease. Mild infections are of little significance, but heavy fluke burden may lead to significant abdominal symptoms. Incidence of echinostomiasis is higher in Southeast Asian countries, and this report is an unusual case in India. We discuss general desirability of awareness of this kind of infection and training for better detection.

Rare Case of Polymicrobial Keratitis With Balantidium coli.

Purpose: To report a rare case of polymicrobial keratitis due to Balantidium coli and gram-negative bacteria, Pseudomonas aeruginosa and Klebsiella pneumoniae, in a soft contact lens (CL) wearer. Methods: We report a case of CL-related keratitis due to B. coli, P. aeruginosa, and K. pneumoniae. Results: The culture of the corneal scrapings, the CL cleaning solution, and the CL revealed the growth of a rare ciliated parasite, B. coli, along with gram-negative bacteria, namely, P. aeruginosa and K. pneumoniae. The patient was successfully treated with topical broad-spectrum antibiotics and intravenous metronidazole. Conclusions: Polymicrobial keratitis has seldom been reported with B. coli as the causative agent. CL wear can be a risk factor for this infection. Treatment with topical antibiotics may not suffice, and the intravenous route of antiprotozoal drugs may be a useful adjunct. Increasing awareness, early diagnosis, and treatment may improve the final visual outcome.

Gauze Filtration Technique for Quick and Inexpensive Diagnosis of Intestinal Parasites

Intestinal parasitic infestation has been a major public health problem throughout the world, particularly in developing countries owing to unhygienic living conditions. Early and accurate diagnosis as well as improvement in detection rates of intestinal parasites is of prime importance in limiting the incidence of parasitic infestations and decreasing the disease burden. In the present study, we introduce a novel gauze filtration technique to improve the detection rates of intestinal parasites. The technique is simple, inexpensive and time-saving. Detection rate is 96.5% compared to the sedimentation technique, which was considered as the gold standard. This technique can be utilized in peripheral laboratory settings with limited resources and untrained personnel.