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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 23 | Issue 1
Page Nos. 1-44

Online since Thursday, September 16, 2021

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REVIEW ARTICLE  

Fungal infections of the eye p. 1
Savitri Sharma
DOI:10.4103/jacm.jacm_53_21  
Fungi are living organisms that are useful in the nature for cellulose degradation and decay of organic matter. They are useful for antibiotic synthesis and food maturation. At the same time there are several species that are pathogenic to man, animals and plants. They can cause infections in ocular tissues such as cornea, sclera, choroides, retina and vitreous. Fortunately, fungal infections are not frequent and are basically opportunistic infections. The exogenous infection is more common in tropical and subtropical parts of the world owing to their abundance in the environment as saprophytes. Prolonged treatment with corticosteroids or broad spectrum antibiotics, diabetes, acquired immunodeficiency syndrome, organ transplantation, malignancy and immunodeficiency conditions are some of the risk factors that may contribute to fungal infections. This review article is confined to ocular fungal infections, their pathogenesis, epidemiology, clinical features and laboratory diagnosis in brief. By far, fungal infections are easier to diagnose than treat. Availability of antifungal drugs is limited and a majority of them have serious side effects. Antifungal susceptibility testing is not common and data related to the development of resistance are meagre. Ophthalmic preparations for the treatment of fungal infections of the eye are very few and off label use of systemic antifungals as topical drugs is common. The science of fungal ocular infections is still evolving, with increasing data coming from just a few countries.
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ORIGINAL ARTICLES Top

Enzyme-linked immunosorbent assay as a substitute for immunofluorescence assay: An analysis of different serological tests in diagnosis of scrub typhus p. 9
Asfia Sultan, Afaf Shuaib, Meher Rizvi, Fatima Khan, Haris M Khan
DOI:10.4103/jacm.jacm_41_21  
BACKGROUND: Among the causes of acute febrile illness, scrub typhus is an important entity. Serology is the mainstay of diagnosis of scrub typhus, with immunoglobulin M (IgM) immunofluorescence assay (IFA) test being the gold standard. Because of cost constraint, IFA cannot be employed for screening or routine diagnosis. This study was planned to evaluate the diagnostic efficacy of different serological test available for Scrub typhus. MATERIALS AND METHODS: Total of 414 cases of undiagnosed acute febrile illness of >5 days were evaluated for scrub typhus. The tests employed were Weil-Felix, rapid immunochromatographic test, IgM enzyme-linked immunosorbent assay (ELISA) and IgM IFA. Performance of all the tests was evaluated against gold standard IFA test by IBM SPSS version 20.0 (SPSS Inc. Chicago, USA) and MedCalcsoftware. RESULTS: Total of 112 (27%) were positive by ELISA while 32 (7.7%) and 44 (10.6%) cases were positive by Weil-Felix and RDT, respectively. Of these, only 98 (23.6%) samples showed titre of ≥1:64 by IFA. Statistical analysis showed sensitivity and specificity of IgM ELISA, 100 (95% confidence intervals [CI]: 96.31–97.88) and 96.05 (95% CI: 93.34–97.88) respectively. The sensitivity and specificity of RDT and Weil Felix was 64.47 (95% CI: 56.31–72.06) and 57.65 (95% CI: 49.85–65.18) and 100% (95% CI: 98.84–100) and 98.14 (95.99–99.31), respectively. On analysis of association between OD values and IFA titres, Spearman correlation coefficient was 0.783 (P < 0.01) while Pearson correlation coefficient r2 = 0.879(P < 0.01). Youden's index of Weil-Felix, RDT and ELISA was 0.56, 0.64 and 0.96, respectively. CONCLUSION: IgM ELISA has turned out to be a significant tool in diagnosis of scrub typhus.
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'Double Trouble' -Antimicrobial resistance and COVID-19 A study on health care associated infections and multidrug resistant organisms in critical care units during the global pandemic p. 14
K Raksha, Poorani Gopinath
DOI:10.4103/jacm.jacm_44_21  
INTRODUCTION: Healthcare-associated infections (HAIs) contribute to mortality and morbidity in critical care units. The influence of the ongoing coronavirus disease (COVID-19) pandemic on the already existing silent pandemic of antimicrobial resistance, especially in a critical care setting in our experience, is discussed here in this perspective. MATERIALS AND METHODS: In our prospective single-centred study over three months (July to September 2020), 123 COVID-19-positive patients admitted in the medical and surgical intensive care units (ICUs) were enrolled after institutional ethical clearance and informed consent. Patient characteristics and risk factors for HAIs were studied using univariate analysis. Antimicrobial usage was monitored based on high-end antibiotic usage monitoring policy. RESULTS: Of 123 COVID-19 patients, 98 were mechanically ventilated and 47% (46/98) developed ventilator-associated pneumonia (VAP) with predominant strain of multidrug-resistant (MDR) Klebsiella pneumoniae. In patients with central line, 26% (10/38) developed central line-associated bloodstream infection (CLABSI) with coagulase-negative Staphylococcus. In catheterised patients, 51% (23/45) developed catheter-associated urinary tract infection (CAUTI) with predominant MDR K. pneumoniae and Acinetobacter baumannii complex. The significant risk factors for VAP were acute respiratory distress syndrome (ARDS), acute kidney injury, duration of mechanical ventilation, steroid therapy and longer ICU length of stay. Patients with CAUTI had diabetes and chronic kidney disease, were on steroids and had a longer ICU stay. Patients with CLABSI had more ARDS, had diabetes, were mechanically ventilated longer and had longer ICU stay. A 57%–84% increase in consumption of antibiotics was seen in our set-up with Azithromycin, Colistin, Meropenem and newer β-lactam/β-lactamase inhibitor combinations like Ceftazidime/Avibactam. CONCLUSION: HAIs in a critical setting with patients admitted with COVID-19 need special focus in terms of prevention and control. In our study, we highlight the incidence of VAP and a need to monitor these key quality indicators including antimicrobial prescription practices.
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Determining the feasibility of constructing a real-time polymerase chain reaction instrument locally: The cost of intellectual property rights and research and development p. 18
Saptati Bhattacharjee, Sanjay Bhattacharya
DOI:10.4103/jacm.jacm_45_21  
BACKGROUND: Real-time polymerase chain reaction (PCR) machines have advanced the field of microbiology by introducing a robust method for high-throughput detection of nucleic acid targets. Unfortunately, these instruments are quite expensive to purchase and maintain, despite containing hardware parts that are relatively inexpensive. AIMS AND OBJECTIVES: We believe that it may be possible to mitigate costs in low- and middleincome countries (LMICs) by building such a PCR instrument from assembled parts. However, the major hindrance is the cost of intellectual property rights (IPRs), associated with research and development (R and D). The aim of this project was to understand the hardware costs, IPR royalties, profit margins, and the cost of R and D associated with PCR instrument manufacturing. MATERIALS AND METHODS: We conducted a review of two PCR machines to examine the differences in their technical and hardware specifications and quantify the cost of assembled parts alone. We also ran a parallel assay using the two machines to understand how the differences in technologies affected assay results. RESULTS AND CONCLUSION: Based on our analysis, we found that assembling a PCR machine using assembled parts can make these instruments more affordable in LMICs. There is a need to have collaboration and agreement between machine licensing, patent, and copyright holders to facilitate this process in LMICs.
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Prevalence of needlestick injury and factors associated with needlestick injury among health-care workers in a tertiary care hospital p. 24
Sowmya Sridharan, Yamunadevi Ramanathan, Senthur Nambi Panchatcharam, Ramasubramanian Venkatasubramanian
DOI:10.4103/jacm.jacm_47_21  
INTRODUCTION: One of the most common causes of occupational injury in hospitals is needlestick injury (NSI). Most injuries are self-inflicted but a few are inflicted by coworkers. The WHO reports that out of the 35 million health-care workers (HCWs), 2 million experience percutaneous exposure to infectious diseases each year. Early and prompt reporting of NSI enables hospitals to provide post-exposure prophylaxis and counselling as needed. Here, we present our hospital data for the year 2019. AIMS AND OBJECTIVES: The aim and objective of the study are to calculate the incidence of NSI among HCWs in our hospital for the year 2019 and to analyse the reasons for the NSI and to formulate corrective actions for the same. MATERIALS AND METHODS: A retrospective observational study of NSI from 1 January 2019 to 31 December 2019 at our tertiary care hospital. We performed a root cause analysis for the same. RESULTS: A total of 59 cases of NSI were documented. The highest incidence of NSI was in the operation theatre(47.45%). Among all health care workers, doctors had the highest NSI incidents(40.6%), Around 63%(37) of the cases happened due to technique errors such as improper handling (while passing sharp instruments) and poor sharp management (while loading the scalpel blade over the handle). CONCLUSION: NSI is a fully preventable occupational hazard. Prompt reporting of NSI is needed for corrective measures.
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Prevalence of intestinal parasites in the patients with suspected gastrointestinal infections p. 29
Upninder Kaur, Taruna Kaura, Sofia Rani, Rakesh Sehgal
DOI:10.4103/jacm.jacm_52_21  
BACKGROUND: Intestinal parasitic infections (IPIs) are considered a serious public health problem worldwide, particularly in developing countries. It is important to study the trend distribution of IPIs in a particular community. The prevalence rate of intestinal parasites in the present study was undertaken in patients who were reported with suspected gastrointestinal infections at PGIMER, Chandigarh, from May 2013 to April 2017. MATERIALS AND METHODS:A four-year study was conducted in which all the suspected patients having gastrointestinal infections attending both Nehru Hospital and Outpatient Department attached to Post-Graduate Institute of Medical Education and Research, Chandigarh, were analysed for IPIs at Department of Medical Parasitology, PGIMER, Chandigarh. Direct microscopic examination of stool samples was done using saline and iodine preparations. RESULTS: 1042/2404 samples were found to be positive for intestinal parasites. The predominant parasite isolated was Giardia lamblia with a prevalence rate of 68.9% followed by Entamoeba histolytica (14.9%). The present study showed preponderance of males (69.2%) than females (30.7%). The most affected age group varied with the type of IPI and maximum cases were observed in monsoon period. CONCLUSIONS: The epidemiological studies of these parasites are necessary for effective prevention and control strategies. More surveillance studies, therefore, should be planned to establish the exact proliferation and prevalence of intestinal parasites in a particular region.
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RESEARCH NOTE Top

Containment of COVID-19 outbreaks in a non-COVID hospital – An experience p. 34
Kavita Raja, EK Jyothi, KP Dinoop, Shiny Biju
DOI:10.4103/jacm.jacm_42_21  
This brief communication describes the preventive measures taken to prevent the spread of COVID-19 in a non-COVID hospital and the outcome. In the initial stages of the pandemic, small clusters of cross-infection occurred within wards and intensive care units, but containment measures that are described reduced the cross-infection and spread inside the non-COVID hospital. However, reduction could also be due to the fall of infections in the community. Hence, the fact that reduction was due to these containment measures was proved by expressing the number as a percentage of the state positives, from 150 (0.13%) out of 111,891 positive in the state in September 2020 – 63 (0.04%) out of 157951 positive in the state in December 2020.
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CASE REPORTS Top

Fungal brain abscess: Clinical experience and review of literature p. 38
S Sidharth, R Jyothi, N Saritha, H Sahira, KL Sarada Devi
DOI:10.4103/jacm.jacm_51_21  
Fungal brain abscess is an unusual but serious complication associated with immunosuppression. Two case reports of fungal brain abscess are presented here. The first case is of a young female who developed multiple Scedosporium apiospermum brain abscesses after near-drowning with the aspiration of contaminated mud and water. The second case is of a young male with a history of intravenous drug abuse who developed Cladophialophora bantiana brain abscess. C. bantiana, a dematiaceous fungus, is a rare aetiological agent of intracerebral abscesses and such infections carry high mortality due to the delay in the diagnosis and absence of standardized therapy. Both patients recovered after the removal of abscesses along with long-term antifungal treatment with amphotericin B and voriconazole.
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Mixed infection of Plasmodium vivax and Plasmodium falciparum diagnosed by polymerase chain reaction p. 43
Davinder Kaur, Taruna Kaura, Upninder Kaur, Rakesh Sehgal
DOI:10.4103/jacm.jacm_36_21  
We have reported two cases of mixed infection of Plasmodium species, namely Plasmodium vivax and Plasmodium falciparum, whose DNA was tested by nested polymerase chain reaction (PCR). One case was a 29-year-old male, who presented fever and diurnal variation. He belonged to Jharkhand but was admitted in the emergency ward of PGIMER, Chandigarh, while the other was a 21-year-old female from Aligarh, Uttar Pradesh, who was admitted to PGIMER, Chandigarh, with complaints of fever and vomiting. Smear test of peripheral blood of both the patients found the presence of P. falciparum while nested PCR diagnosis detected the DNAs of both P. vivax and P. falciparum.
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