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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 24 | Issue 1
Page Nos. 1-47

Online since Monday, July 11, 2022

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INVITED DRUG REVIEW  

Isavuconazole - The new triazole p. 1
Jayanthi Savio
DOI:10.4103/jacm.jacm_11_22  
The increase in susceptible population to invasive fungal infections, especially candidemia and aspergillosis has resulted in the introduction of newer antifungal agents, especially in the azole group. Isavuconazole is one such agent with an extended antifungal spectrum. It is found to be useful not only in the management of candidemia and aspergillosis but also mucormycosis.
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ORIGINAL ARTICLES Top

Knowledge, attitude and practices toward prevention of Hepatitis B Virus infection among medical students: A cross-sectional study p. 8
Madhurya H Sachidananda, TA Dhanalakshmi, D Venkatesha
DOI:10.4103/jacm.jacm_2_22  
CONTEXT: A critical level of knowledge and awareness about hepatitis B infection and its prevention among the medical students is essential to decrease the burden of occupationally acquired hepatitis B infection. AIM: To assess the knowledge, attitude and practices (KAPs) among medical students toward HBV infection and its prevention. SETTING AND STUDY DESIGN: This was a cross-sectional questionnaire-based study done in a rural medical college. MATERIALS AND METHODS: Written informed consent and Institutional Ethical Committee clearance were taken. Study included 403 randomly selected medical students. Self-administered pre-tested and pre-validated questionnaire containing KAPs items was used as study tool. The responses were recorded in terms of agree, disagree, not sure, yes and no formats. STATISTICAL ANALYSIS: Data are expressed in frequencies and percentages. RESULTS: Majority of students were aware of modes of transmission of HBV infection (67%–91%). Only 28.5% of participants agreed that hepatitis B vaccine is used for post-exposure prophylaxis. They had good attitude toward preventive aspects of hepatitis B infection (71%–96.3%). Only 52.9% had taken three doses of hepatitis B vaccination and only 4% of them got tested for antibodies titre post-vaccination. CONCLUSION: The present study demonstrated gap in the knowledge and practice. This gap should be addressed by implementation of orientation programmes on HBV and mandatory vaccination of medical students at the time of entry to the institution.
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Antibiotic susceptibility pattern in clinical isolates of Enterococci at a tertiary care hospital p. 12
Kavita Thakan, Akshat Vij
DOI:10.4103/jacm.jacm_1_22  
INTRODUCTION: Enterococci have emerged as leading causes of healthcare-associated infections globally. Glycopeptide-resistant Enterococci have become a major threat to hospitalised patients, causing outbreaks that increase morbidity, mortality and healthcare-associated costs. MATERIALS AND METHODS: All samples were inoculated on appropriate culture plates. Confirmation was done by performing Gram's stain, catalase test and bile-esculin hydrolysis. Antibiotic susceptibility testing was performed using modified Kirby–Bauer's disk diffusion method. Vancomycin resistance in Enterococci was detected by performing Epsilometer test on Mueller–Hinton agar, and results were interpreted as per CLSI guidelines (2019). RESULTS: Totally 75 isolates of Enterococci were isolated. The highest resistance in all isolates was against Ciprofloxacin (88%), Erythromycin (81.30%) and Ampicillin (77.33%). The most effective drugs were Linezolid with only 2.66% resistance and Vancomycin with 10.66% resistance. High-level Gentamicin (HLG) resistance was seen in 58.66% of cases and high-level Streptomycin (HLS) resistance was seen in 53.33% of cases. Totally 35 strains showed a combined resistance for both HLG and HLS, which was 46.66%. A total of seven cases were Vancomycin-resistant Enterococci (VRE), 85.6% of which showed high-level Aminoglycoside resistance (HLAR). Resistance for Linezolid was reported at 28.6%. CONCLUSIONS: Female patients presenting with urinary tract infection are the most common patients with enterococcal infections, with hospitalised patients being more prone, especially in the middle age groups. Appropriate antibiotics need to be instituted after performing antibiotic susceptibility testing to reduce treatment failure arising from HLAR and VRE strains. All VRE isolates should be tested for minimal inhibitory concentration before declaring them Vancomycin resistant.
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Evaluation of rapid antigen test against reverse transcription-polymerase chain reaction for the diagnosis of severe acute respiratory syndrome coronavirus 2 in a tertiary care centre in South Kerala p. 16
OR Reshma, Ashna Ajimsha, Ganga Raju Krishna, KN Deepthi, Kiran Subhash, Ashish Jitendranath, JT Ramani Bai
DOI:10.4103/jacm.jacm_70_21  
BACKGROUND AND OBJECTIVES: The objective of this study was to evaluate the performance of a rapid antigen test against reverse transcription– polymerase chainreaction (RT-PCR) for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in a tertiary care centre in South Kerala. In this study, we compared the performance of a rapid antigen test, coronavirus disease-2019 (COVID-19) Ag Respi-Strip, with that of a real-time PCR assay using PerkinElmer Reagent kit. MATERIALS AND METHODS: A descriptive (diagnostic evaluation) study was conducted at a tertiary care teaching hospital in South Kerala. Samples were taken for RAT and real-time reversetranscriptase–polymerase chain reaction (rRT-PCR) (reference standard) from patients visiting fever clinic in Sree Gokulam Medical College and Research Foundation to calculate the sensitivity, specificity and accuracy of the rapid antigen test. Samples were collected by the following protocols approved by the Institutional Research Committee, Sree Gokulam Medical College and Research Foundation, Trivandrum. Signed informed consent was obtained from all participants. Tests were performed in biosafety level 3 laboratories at the Molecular Laboratory, Department of Microbiology, Sree Gokulam Medical College and Research Foundation, Trivandrum. RESULTS: Of the 241 symptomatic participants, 50 were rRT-PCR positive for SARS-CoV-2. Thirty-nine of these patients also tested positive for SARS-CoV-2 by RAT. The overall sensitivity and specificity were 76% and 99.47%, respectively. We got an accuracy of 94.6%. INTERPRETATION AND CONCLUSIONS: With excellent specificity and moderate sensitivity, a rapid antigen test may be used to rule out COVID-19 in patients. The comparison data obtained in this study indicate that this can be used for rapid screening of patients with high SARS-CoV-2 viral load, but the rate of sensitivity is highly dependent on computed tomography value. This method also enables instrument-free and low-cost point-of-care testing. However, it depends on various factors such as viral loads and clinical status, which could significantly influence the final performance of the antigen test. Hence, negative results from an antigen test may need to be confirmed with a molecular test before treatment.
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Comparison of TrueNat polymerase chain reaction and mycobacterium growth indicator tube culture in the diagnosis of pulmonary and extrapulmonary tuberculosis p. 21
Poornima Mankara Valsan, J Sudarasana
DOI:10.4103/jacm.jacm_6_22  
Many diagnostic tests are available for tuberculosis (TB), from light microscopy, fluorescent microscopy, solid culture, liquid culture (Mycobacterium growth indicator tube [MGIT] culture) to molecular methods. The turnaround time and sensitivity of these tests vary depending on the procedure and principle involved. Based on this background, we compared the results of TrueNat Mycobacterium TB (MTB) Polymerase chain reaction (PCR) and MGIT culture in different clinical samples. A retrospective study was conducted in a tertiary care Hospital Kozhikode, Kerala from December 2018 to October 2021. A total of 431 samples (342 extrapulmonary and 119 pulmonary) were received in the laboratory for both TrueNat MTB PCR and MGIT culture. The samples sent for a single test and/or inadequate volume of samples for both tests were excluded from the study. In extrapulmonary samples, TrueNat MTB PCR and MGIT culture were positive for 31 (9%) samples. MGIT culture was positive in 48 (14%). Seventeen samples (5%) were positive only by MGIT culture. The sensitivity and specificity of PCR in extrapulmonary TB samples are 65% and 70%, respectively. Eighteen pulmonary samples (15%) were positive by both TrueNat PCR & MGIT culture. MGIT culture was positive in 20 (17%) pulmonary samples. Two pulmonary samples were positive by MGIT culture only. The sensitivity and specificity of PCR in pulmonary samples are 90% and 96%, respectively. Accurate diagnosis followed by prompt treatment is vital for the elimination of TB from our country by 2025. PCR is found to be a very rapid method in the early diagnosis of TB. However, culture still remains the gold standard test for the diagnosis.
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The blue 'solution': Evaluation of methylene blue as a screening test for the diagnosis of significant bacteriuria p. 26
Anna Rachel Menezes, Baijayanti Mishra
DOI:10.4103/jacm.jacm_7_22  
BACKGROUND: In the year 2014, Nnaemeka and Iyioku in Nigeria developed the methylene blue screening test and advocated for further study regarding the evaluation and usage of the test in a low-resource setting. In this study, we aimed to establish a clear cut-off absorbance for a good predictive value, evaluate the sensitivity and specificity of the test, compare the results to available screening methods and determine the applicability of the test in screening for bacteriuria that does not adhere to Kass criteria and hence thoroughly evaluate the test for external validation before use in low-resource settings. MATERIALS AND METHODS: In this study, a total of 217 urine samples were run through the modified methylene blue test and culture, i.e., the gold standard for diagnosis of significant bacteriuria; using the results, a cut-off was derived using receiver operating characteristic curve analysis. Statistical analysis was then performed using the cut-off. The minimum colony count was determined for the given cut-off to predict whether the test can be used in different settings of bacteriuria. The above results were then compared to available screening tests based on a thorough literature search on PubMed. RESULTS: Using 0.36 as a cut-off absorbance value, the calculated sensitivity and specificity of the test were 83.5% and 92.9% with a positive predictive value of 90% and a negative predictive value of 87.40% according to the current prevalence of urinary tract infection in South India. The P value of the above result determined using the Chi-square test was <0.05 and hence the results were deemed to be statistically significant. CONCLUSION: The test could precisely diagnose bacteriuria with a colony count of >105 colony-forming units/mL and had comparable sensitivity and specificity to a combination of leucocyte esterase and nitrite tests which are popularly used as screening methods.
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BRIEF COMMUNICATIONS Top

Benefits and limitations of external calibration required to validate the physical parameters of an autoclave: A brief discussion from an oncology centre in eastern India p. 32
Debabrata Basu, Prokash Mondal, SK Rafikul, Sanjib Ghorai
DOI:10.4103/jacm.jacm_5_22  
Validation is a documented procedure for obtaining, recording and interpreting the data required to establish that a process will consistently comply with manufacture's predefined specification. In healthcare facility sterilizer validation is often required because continuous operations and their relevant age, the machine may give false results that compromise the sterility assurances. Because early prediction of steriliser malfunctioning is impossible, and malfunction gets detected only when it runs. The main objective of this article is to discuss about the requirement of only autoclave physical parameters calibration is how much effective without using of chemical or biological indicators and what is the drawbacks of this system. The requirement of any steriliser monitoring is to prove that the process is effective and can deliver a product that is reproducible and meets the required quality requirements. A successful load monitor always meets all the acceptance criteria of an entire load, and gives a well validated sterility assurance.
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Is adenosine triphosphate test really required in hospital sterile supply quality monitoring purposes: An observation done in an oncology centre in Eastern India p. 35
Debabrata Basu, Sanjay Kishore Dutta, Subhas Chandra Bag, Arijit Das, John Debdutta Rozario
DOI:10.4103/jacm.jacm_69_21  
Assessment of cleaning is an important part for ensuring health and hygiene, especially before disinfection and sterilisation procedure. Cleaning assessment can be done by different techniques. Although there is no standard to define when a device is 'Clean', from various study, it is observed that proper cleaning can reduce more than 90% bio-burden on any object. The cleaning and disinfection monitoring in Central Sterile Supply Department are to ensure that subsequent cleaning and disinfection process is successful. To verify cleaning monitoring of surgical instruments, the ATP testing method is fast, technically effective and easiest way among all other cleaning assessment techniques.
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CASE REPORTS Top

Discrepancy in methicillin sensitivity of Staphylococcus aureus between molecular and phenotypic assays p. 38
Pradnya Laxman Samant, Gaurav V Salunke, Sanjay K Biswas
DOI:10.4103/jacm.jacm_4_22  
Since the emergence of MRSA six decades ago, it continues to reign as a threatening pathogen in the health-care and community settings. Correct identification of Staphylococcus aureus as MRSA/MSSA is important to aid in antimicrobial stewardship. In the present study, S. aureus from a joint aspirate was identified as MRSA by molecular method; however, phenotypic method confirmed it as MSSA.
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Aggregatibacter aphrophilus, a HACEK group pathogen as a cause of prosthetic valve endocarditis p. 41
Jyothi Embekkat Kaviyil, Dinoop Korol Ponnambath, Bijulal Sasidharan, Pravi Vidyadharan, Kavita Raja
DOI:10.4103/jacm.jacm_8_22  
Prosthetic valve endocarditis (PVE) is one of the most severe forms of infective endocarditis. Here, we describe a case of PVE caused by Aggregatibacter aphrophilus, a member of the HACEK group of pathogens, which is a difficult pathogen to identify using conventional methods. The pathogen was identified by 16s rRNA Sanger sequencing using eight-channel capillary electrophoresis method.
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An unusual guest in an unusual location of the brain of a rural tribal man p. 44
Dinoop Korol Ponnambath, Jyothi Embekkat Kaviyil, Kavita Raja, Krishnakumar Kesavapisharady, Bejoy Thomas, Deepti Narasimhaiah, Rakesh Sehgal, Upninder Kaur
DOI:10.4103/jacm.jacm_9_22  
We report a rare occurrence of central nervous system hydatid disease involving the occipital lobe caused by Echinococcus multilocularis in an immunocompetent rural tribal man. A 40-year-old man presented with gradual onset of headache for 6-month duration with associated seizures and giddiness. Neurological examination revealed cerebellar signs with visual field defect. Magnetic resonance imaging revealed a multilobulated cystic lesion with membranous septations and peri-lesional oedema involving the left occipital lobe. Wet mount examination of the aspirated cystic fluid showed multiple daughter cysts and hooklets with histopathological examination showing features suggestive of hydatid disease. The identification of the causative organism was confirmed as E. multilocularis by conventional polymerase chain reaction. The patient's condition improved during the post-operative period and was discharged 2 days later, on oral albendazole for 3 months. At 2 years follow-up, the patient neurological symptoms have recovered with minimal visual field defect.
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