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   2015| July-December  | Volume 17 | Issue 2  
    Online since December 15, 2015

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Amoebic vs pyogenic liver abscesses: A comparative study in a tertiary care hospital
Ardra R Menon, Pushpa K Kizhakkekarammal, Girija K Rao
July-December 2015, 17(2):89-93
Background and Objectives: Liver abscess is a potentially life-threatening condition with a majority of cases being amoebic in tropical countries. In India, poor sanitary conditions and low socioeconomic status contribute to the endemicity of amoebiasis. As treatment modalities are different for amoebic and pyogenic liver abscesses (ALA and PLA, respectively), it is necessary to differentiate them. Facilities for amoebic culture are not available and microscopy is nondiscriminatory, hence serological tests are greatly relied upon for the identification. No studies have been done so far in our region on patients admitted with liver abscess. The aims of this study were to find the aetiology of liver abscess in admitted patients and to know the proportion of amoebic liver abscess using serological techniques. Materials and Methods: The study was done for 6 months and the sample size was 50. The ultrasonography (USG)-guided aspirates were subjected to microscopy and aerobic and anaerobic cultures on appropriate media. Serum samples of all patients were examined for Entamoeba histolytica immunoglobulin G (IgG) antibodies by enzyme-linked immunosorbent assay (ELISA) along with 35 control samples. Results: Of the 50 patients, 34 were diagnosed as amoebic by (ELISA) (68%), 11 as pyogenic (22%) and five as indeterminate (10%). Alcohol was found to have a higher association with ALA than with PLA. Of the 34 amoebic liver abscesses, only four (8.8%) showed motile trophozoites. The mortality rate was only 2.2%. Conclusion: Rapid diagnosis with serology and prompt treatment can result in reduced hospital stay in cases of ALA.
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Serratia marcescens conjunctivitis due to nasolacrimal duct obstruction
Anna Cherian
July-December 2015, 17(2):119-120
A case of a 3-month-old child with conjunctivitis subsequent to nasolacrimal duct (NLD) obstruction is reported. Serratia marcescens (S. marcescens) was cultured from the discharge from the left eye; the child was treated and cured effectively with appropriate antibiotics.
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Prevalence of group A streptococcal pharyngitis among schoolchildren of Barabanki district, Uttar Pradesh, India
Amit Kumar Singh, Akash Kumar, Loveleena Agarwal, Anjali Agarwal, Chandrim Sengupta
July-December 2015, 17(2):110-114
Background: The aim of this study was to determine the prevalence of Group A streptococcus (GAS) pharyngitis and its carriage among schoolchildren in the age group 5-15 years in Barabanki district, Uttar Pradesh, India. The study also aimed to determine the minimum inhibitory concentration (MIC) of Penicillin G, antimicrobial susceptibility pattern and inducible Clindamycin resistance in GAS. Materials and Methods: Three hundred schoolchildren from six different schools were included in the study. Identification of group A streptococcus was done on the basis of Bacitracin sensitivity test, pyrrolidonyl peptidase (PYRase) test and Lancefield grouping by latex agglutination test. Antibiotic susceptibility test and D-zone test were done in GAS isolates. Results: Out of the 300 schoolchildren, GAS was found in three (4.7%) out of 63 symptomatic children and two (0.8%) out of 237 asymptomatic children. The overall prevalence of GAS pharyngitis and of GAS carriage was 1% and 0.67%, respectively. The isolation of GAS was significantly higher in symptomatic cases when compared to asymptomatic cases (P value = 0.0308). All the strains were sensitive to Penicillin, Ampicillin, Quinupristin-Dalfopristin, Vancomycin and Linezolid. Conclusion: A low prevalence of GAS pharyngitis and GAS carriage was observed in the study, probably due to the cross-sectional nature of the study. All five GAS isolates were sensitive to Penicillin.
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Utility of latex agglutination test (LAT) in detecting acute bacterial meningitis against culture as gold standard
R Jyothi, JT Ramani Bai
July-December 2015, 17(2):84-88
Background: Bacterial meningitis is a medical emergency. It is a major cause of death and disability worldwide. Immediate steps must be taken to establish the cause and initiate effective therapy. Though Gram staining is essential in diagnosis of meningitis, some cases may be missed. Culture and latex agglutination tests (LATs) help to overcome this disadvantage. Objective: This study was conducted to find out the sensitivity of the LAT in acute bacterial meningitis against culture as the gold standard. Materials and Methods: Cerebrospinal fluid (CSF) samples were collected aseptically in dry, sterile bottles from all cases of bacterial meningitis by lumbar puncture from August 2011 to December 2013. They were subjected to cell count, Gram staining, culture and LAT. Results: Out of 538 samples, aetiological agents were identified by Gram stain and culture or LAT in 52 cases. Streptococcus pneumoniae was isolated in 22 (42%), Haemophilus influenzae type b in 14 (26.9%), Neisseria meningitidis in three (5.6%), Group B streptococci in three (5.6%), Klebsiella pneumoniae in six (11.5%), Acinetobacter baumannii in two (3.84%) and Escherichia coli in two (3.84%) cases. In the present study, the LAT for H. influenzae type b; Streptococcus pneumoniae; Neisseria meningitidis A, B, C, Y and W135; Group B streptococci; and E. coli K1 antigen had a sensitivity of 74.1%, specificity of 95.8%, positive predictive value 52.1% and negative predictive value 98.3%. Conclusion: LAT cannot replace the utility of culture. Despite its drawbacks, LAT is a simple, rapid procedure, suitable to be used as an adjunct laboratory test for establishing the aetiological diagnosis of bacterial meningitis, particularly in partially treated cases.
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Hookworm infection: An unusual presentation
Anitha P Moorkoth, Shabina M Balakrishnan, Jyothi P Thayyilekandi, Kalpana George
July-December 2015, 17(2):121-123
Hookworm infections are widely distributed in the tropics and subtropics, with around 1.3 billion infected globally. Common manifestations of Ancylostoma duodenale and Necator americanus infections include symptoms due to larval penetration, pneumonitis, or the intestinal phase of infection. We report an unusual case of total hyphema with secondary glaucoma in the right eye of a 70-year-old male patient, caused by an adult hookworm in the anterior chamber. The extracted worm was identified to be of Ancylostoma species. The patient was treated with topical steroids, cycloplegics, and oral albendazole. Pain, corneal oedema and secondary glaucoma subsided and his vision improved.
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Urinary Candida isolates from a tertiary care hospital: Speciation and resistance patterns
Anita Singhal, Rajni Sharma, Vijay Laxmi Meena, Arun Chutani
July-December 2015, 17(2):100-105
Background: Candida species (spp.) is an integral member of the human microbiota and is an opportunistic pathogen. This pathogen infects the urinary tract both by ascending the urinary tract and by haematogenous spread. Aim: Speciation and antifungal susceptibility patterns of Candida isolates from urine specimens. Materials and Methods: Yeast-like isolates from urine culture were identified using a Mini-API® (bioMérieux, Marcy-l'Etoile, France) tool with ID 32 C strips (bioMérieux, Marcy-l'Etoile, France) for species identification and ATB Fungus 3 strips (bioMérieux, Marcy-l'Etoile, France) for susceptibility testing to five antifungal agents and results interpreted as per Centers for Disease Control and Prevention (CDC) guidelines. The significance of data was analysed using the chi-square test. Results: Candida spp. isolation was 10.2% (112/1092) and the commonest was Candida tropicalis [54.5% (61/112)], followed by C. glabrata 25% (28/112), and C. albicans, 11.6% (13/112). C. albicans showed good susceptibility to Flucytosine (100%) and Amphotericin B (84.6%) while non-albicans Candida susceptibility was only 82.9% and 60.6%, respectively. Conclusion: Non-albicans Candida have replaced Candida albicans as the more common causative agent. Resistance to both Amphotericin B and Fluconazole is on the rise, requiring the judicial use of antifungals in the immunocompetent and immunocompromised host as therapeutic and prophylactic therapy.
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Prevalence of fungal infections in a tertiary care centre: A retrospective study
Sathya Bhama, Jyothi Rajahamsan, Ramani Bai Joseph Theodore
July-December 2015, 17(2):81-83
Back ground: During recent years, fungal infections have risen exponentially and are a significant cause of morbidity and mortality in hospitalised patients. Fungal infections are commonly observed in patients with uncontrolled diabetes mellitus, organ transplant, use of invasive devices and broad spectrum antimicrobial agents. Objective: A retrospective analysis for a period of one year was undertaken to know the prevalence of common fungal infections in a tertiary care hospital. Materials and Methods: Clinical samples collected from patients presenting with clinically suspected fungal infections were received in the microbiology laboratory attached to the Medical College Hospital, Thiruvananthapuram, Kerala, India. Direct microscopy with 10% potassium hydroxide was done to visualize the presence of fungal elements, and Gram staining was done for any suspected yeast infection. India ink stain was done for cerebrospinal fluid. The samples were inoculated on Sabouraud's Dextrose Agar and kept at 22°C and 37°C. Results: A total of 366 samples with suspected fungal aetiology were included in the study. The isolates were maximum in adults (66.66%). Females (54.5%) were more affected than males (45.5%). There were 81 isolates of which one was yeast, 28 were yeast-like fungi, and 52 were mould fungi. Non-albicans Candida (32.09%) and Aspergillus flavus (20.98%) were the predominant fungal isolates. Conclusion: The predominant isolate obtained in this study was non-albicans Candida. Among moulds, aspergillus species was the most common isolate. An increase in fungal infections may be due to an increase in the number of AIDS patients in our hospital.
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A clinicomicrobiological study of diabetic foot ulcers from South Kerala
Suryakala R Nair, Resmi Rajan, Sharada Devi Karunakaran Lalithabhai
July-December 2015, 17(2):94-99
Background: Infection with multidrug-resistant organisms (MDRO) in foot ulcers is a major cause of morbidity and mortality among diabetic patients in India. The empirical antibacterial therapy based on local prevalence and susceptibility pattern of bacterial isolates can significantly reduce the incidence of complications. Objectives: The study aimed to a) determine the microbiological profile and prevalence of MDRO isolated from diabetic foot infection; b) identify the main risk factors for MDRO; and c) find out the risk of a few selected complications in ulcers infected with MDRO. Materials and Methods: Specimens such as tissue/bone biopsy or syringe aspirates were collected for culture and antimicrobial sensitivity testing from patients with diabetic foot ulcers of Wagner grade ≥2. Cefoxitin disc diffusion method was used for the detection of methicillin-resistant Staphylococcus aureus (MRSA). Standard methods to detect ESBLs, AmpC β-lactamase, and metallo-beta-lactamase were used in multidrug-resistant Gram-negative isolates. Results: Out of 250 patients, 144 (58.3%) had polymicrobial infection and 172 (41.7%) of the 412 isolates were multidrug-resistant. Staphylococcus aureus was the single commonest organism, i.e., 139 (33.7%). Out of 139 Staphylococcus aureus isolates, 62 (44.6%) were MRSA. Gram-negative organisms accounted for the majority of isolates, i.e., 223 (54.1%). Out of 223 Gram-negative organisms, 108 (48.4%) were multidrug-resistant. The commonest Gram-negative bacterium was Pseudomonas aeruginosa, i.e., 77/223 (18.7%). Risk factors for MDRO and outcome of MDRO infection were also analysed. Conclusions: The prevalence of MDRO in our study was nearly 50%, which shows the urgent need for implementation of strict antibiotic policy and infection control measures to avoid antibiotic resistance. The presence of recurrent ulcer, past hospital stay, past foot-related surgery, ulcer size (>4 cm 2 ) and ulcer duration >1 week were identified as the main risk factors for MDRO. Death during hospital stay was significantly higher in the MDRO group, while ulcer healing or amputation was not significantly associated. Finally, an empirical antibiotic policy was also proposed for treating diabetic foot infections.
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What is happening to our Pseudomonas? Trends of susceptibilities of culture-confirmed Pseudomonas aeruginosa infections in a tertiary care hospital
Seema Oommen, PM Sivan Pillai, Rajeev Arivandakshan, Kavitha Nair, Sreeja Nair
July-December 2015, 17(2):75-80
Background and Objectives: Infections due to Pseudomonas aeruginosa, especially healthcare-associated infections, present a significant health problem worldwide. Drug resistance especially multidrug resistance in P. aeruginosa is on the rise. Thus the objective of this study was to determine the sensitivity pattern among clinical isolates obtained from the patients admitted to a tertiary care centre. Materials and Methods: A total of 484 non-duplicate P. aeruginosa isolates in 2014, 444 isolates in 2013, 350 isolates in 2012 and 460 isolates in 2007 were characterized according to their antibiotic susceptibility, and the trends over time were analyzed. Results: There were statistically significant increases in sensitivities of isolates P. aeruginosa from 2007 to 2014 to most of the routinely used antibiotics including Ciprofloxacin. Conclusions: A detailed genomic- and/or proteomic-level study for our isolates is much desired to understand this loss of resistance so that the same may be replicated in other bacteria.
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Aortic ring abscess caused by Streptococcus pluranimalium: A case report
Anupma Jyoti Kindo, Divya Tharmalingam, Uma Sekar, G Nagarjuna, TR Muralidharan, S Thanikachalam
July-December 2015, 17(2):127-129
A 69-year-old male presented with complaints of high-grade intermittent fever for 1 week. The patient is a known case of coronary artery disease. Seven blood samples were sent for culture, and all the samples grew beta haemolytic colonies, which were identified as Streptococcus pluranimalium. The transoesophageal echo finding of the patient was suggestive of aortic ring abscess. Since the patient was not willing for invasive measures, he was conservatively treated with appropriate antibiotics, to which he responded symptomatically.
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Meningococcal meningitis without rash
KM Rafeeda, S Manjusree, Geetha Raveendran, JT Ramani Bai
July-December 2015, 17(2):130-131
Meningococcal meningitis is a major health problem in the developing world. The clinical features may vary from transient fever and bacteraemia to fulminant disease with death ensuing within hours of the onset of clinical symptoms. The classical and clinical manifestations of meningococcal disease have been well described, but atypical presentations if unrecognised, may lead to a delay in treatment and fatal outcome. Here, we report a case of atypical presentation of meningococcal meningitis without classical rash, which was diagnosed and managed successfully.
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Streptococcus intermedius causing brain abscess in a child with acyanotic congenital heart defect
Swapna Helen John, Radhakutty Amma, Chithra Jayaprakash, Shareen George
July-December 2015, 17(2):124-126
Streptococcus intermedius (S. intermedius) belongs to the Streptococcus anginosus group (SAG) along with Streptococcus anginosus (S. anginosus) and Streptococcus constellatus (S. constellatus). Though all the members of SAG have a propensity to cause deep-seated abscesses at a wide range of sites, when it comes to brain abscesses, it is S. intermedius that is most often implicated. Paediatric population with congenital cyanotic heart disease are especially at risk for developing brain abscess. However, it is a rare occurrence in acyanotic congenital heart diseases. Here, we report a case of frontal brain abscess caused by S. intermedius in a child with a clinically silent atrial septal defect (ASD). However, an echocardiogram revealed a patent foramen ovale (PFO) accompanying the ASD. The child recovered, following burr hole aspiration and 21 days of antibiotic therapy. We report this case to highlight the importance of this pathogen in the aetiology of the brain abscess and due to the rarity of the case.
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Prevalence of multidrug-resistant tuberculosis among category II treatment failures in North Karnataka
Mohammed Ashraf Ali S Namaji, Shobha D Nadgir, KB Jnaneshwara, DS Shylendra, Mahesh S Kumar, AM Yashwant
July-December 2015, 17(2):106-109
Introduction: The worldwide emergence of multidrug-resistant tuberculosis (MDR-TB) is a major threat to tuberculosis (TB) control. Objectives: This study was undertaken to know the prevalence of MDR-TB among category II patients, who were treatment failures, in North Karnataka. Materials and Methods: Category II pulmonary TB includes those patients who are treatment failures, relapsed after treatment or defaulted during previous treatment. Only the patients who had failed previous treatment were included in the present study. Sputum samples obtained from all these patients, received between January 2014 and June 2014, were subjected to microscopy by the Ziehl-Neelsen (ZN) method, as per Revised National Tuberculosis Control Program (RNTCP) protocol. Sputum-positive samples were subjected to drug susceptibility testing by the rapid molecular assay, line probe assay (LPA). Results: A total of 379 patients were enrolled. Of these, 355 patients' sputum samples were positive for acid-fast bacilli (AFB) and one sample negative for AFB was culture-positive. All of these were subjected to LPA. The total number of MDR-TB detected was 71 (18.73%) patients. Mono-drug resistance to Rifampicin was detected in 30 (7.91%) and Isoniazid resistance in 32 (8.44%) patients. Conclusions: The magnitude of resistance being considerably high among the patients with treatment failures, it is essential to screen these patients for MDR-TB. Rapid diagnostic tests (molecular tests) such as the LPA will facilitate the diagnosis of MDR-TB at an early stage and thus will minimise transmission of the disease.
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Nasal carriage of Staphylococcus aureus among the interns before and after posting in the department of surgery at a tertiary care hospital
Priyanka Majety, Puah Soo Huan, Lim Shu Syi, Sahana S Murthy, Harsha Vardhana, Subba Rama Prasad
July-December 2015, 17(2):115-118
Context: Staphylococcus aureus could be a commensal in the anterior nares of a health-care personnel. There are no studies on Staphylococcal nasal carriage among interns before and after posting in the department of surgery. Aims: To find out the prevalence of Methicillin-sensitive S. aureus (MSSA) and Methicillin-resistant S. aureus (MRSA) among interns before and after the surgical posting. Settings and Design: A cross-sectional study was carried out on interns at the time of entry and exit from their surgical posting in a tertiary care hospital. Methods and Material: Paired nasal swabs, collected at the entry and exit, from anterior nares of 130 interns during their 60-day surgical posting, were cultured, and Methicillin-sensitive S. aureus (MSSA) and MRSA were detected. The sensitivity pattern of MRSA strains was determined. The knowledge of spread and prevention of MRSA among interns was assessed. Results: MSSA was detected in the anterior nares of 36 (27.7%) interns at entry had dropped significantly to 19 (14.6%) by the end of the surgical posting. The prevalence of MRSA rose from 6 (4.6%) to 8 (6.2%) by the end. Autoinfections among two persistent carriers were detected. Out of 88 interns who had normal flora, 84 (95.5%) retained it after the surgery posting. Among the 14 MRSA strains isolated in the study, 12 (85.7%) were resistant to Ciprofloxacin, 7 (50%) were resistant to Erythromycin, and 4 (28.6%) were resistant to Clindamycin. Almost half of the interns, who responded to a questionnaire, were unaware of the mode of spread of MRSA and measures to prevent it. Conclusions: Nineteen (14.6%) interns in our study were intermittent carriers of S. aureus. Interns need to be educated on the spread and prevention of Staphylococcal infections.
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Academy News by Secretary, ACM
Chithra Valsan
July-December 2015, 17(2):71-72
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Editorial comments on JACM, Vol 17, No. 1, Jan-Jun 2015
Asma Rahim
July-December 2015, 17(2):73-74
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Vibrio cholerae O1 El Tor from a hilly tribal family in Idukki, Kerala
Sheeba K Thomas, Suresh S Kallayam
July-December 2015, 17(2):132-133
Vibrio cholerae O1 El Tor Inaba was isolated in 2011 from two related individuals from Anchuruli in the Idukki Dam area near Kottayam, Kerala. This is the first documented report of cholera in a hill tribe in the state, and the rare mode of transmission and its significance is discussed.
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