Secondary Infections in Swine Flu.

Swine influenza is respiratory disease of pigs caused by type A influenza virus that causes regular outbreak in pigs. Human to human transmission occurs. Some people develop severe respiratory symptoms and need ventilator. Patients can get secondary bacterial infections in form of pneumonia if viral infections persist. Death of swine flu occurs due to secondary bacterial infections leading to bacterial pneumonias. Method : 369 patients having acute respiratory illness suspected to be suffering from swine flu were included. Real time reverse transcriptase polymerase chain reaction (RT-PCR) was performed on sputum samples or tracheal aspirates of 134 patients admitted in Hospital due to pneumonia. 90 of these patients were positive for swine flu by RT-PCR. Result : Among 90 patients 55 patients’ shows bacterial growth and 35 patients did not show any growth. Maximum patients 17 shows Klebseilla pneumoniae,17 show Staphylococcus aureus ,10 show Escherichia coli,8 show Pseudomonas aeruginosa and 3 patients show Streptococccus pneumoniae. Even after treatment, death of 36 patients occurred. Among these 36 patients, 19 had both, bacterial as well as swine flu infection and 17 patients had only swine flu infection. Conclusion : Secondary bacterial infections in swine flu patients were multiresistant to antibiotics were noted. Pneumonia caused by co-infection contributes to a severe rapidly progressive illness.

Methicillin resistant Staphylococcus aureus (MRSA) in India Prevalence & susceptibility pattern.

Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA) is endemic in India and is a dangerous pathogen for hospital acquired infections. This study was conducted in 15 Indian tertiary care centres during a two year period from January 2008 to December 2009 to determine the prevalence of MRSA and susceptibility pattern of S. aureus isolates in India. Methods: All S. aureus isolates obtained during the study period in the participating centres were included in the study. Each centre compiled their data in a predefined template which included data of the antimicrobial susceptibility pattern, location of the patient and specimen type. The data in the submitted templates were collated and analysed. Results: A total of 26310 isolates were included in the study. The overall prevalence of methicillin resistance during the study period was 41 per cent. Isolation rates for MRSA from outpatients, ward inpatients and ICU were 28, 42 and 43 per cent, respectively in 2008 and 27, 49 and 47 per cent, respectively in 2009. The majority of S. aureus isolates was obtained from patients with skin and soft tissue infections followed by those suffering from blood stream infections and respiratory infections. Susceptibility to ciprofloxacin was low in both MSSA (53%) and MRSA (21%). MSSA isolates showed a higher susceptibility to gentamicin, co-trimoxazole, erythromycin and clindamycin as compared to MRSA isolates. No isolate was found resistant to vancomycin or linezolid. Interpretation & conclusions: The study showed a high level of MRSA in our country. There is a need to study epidemiology of such infections. Robust antimicrobial stewardship and strengthened infection control measures are required to prevent spread and reduce emergence of resistance.

Prevalence of JAK2 V617F mutation in Indian patients with chronic myeloproliferative disorders.

Background & objectives: The Janus-associated Kinase-2 mutation JAK2 V617F in chronic myeloproliferative disorders (CMPDs) has been described as a frequent genetic event in majority of patients with polycythemia vera (PV), essential thrombocythemia (ET) and idiopathic myelofibrosis (IMF). Its frequency varies in different populations but there are no data from India. We therefore, looked for JAK2 V617F mutation in Indian patients with chronic myeloproliferative disorders. Methods: Mutation screening for JAK2 V617F in patients with polycythemia vera, essential thrombocythemia and idiopathic myelofibrosis was performed in 75 patients attending Haematology clinic in a tertiary care hospital in north India, by polymerase chain reaction and restriction enzyme-based assay. Results: JAK2 V617F mutation was found in 51 of 75 cases (68%) of CMPD, 82 per cent in PV, 70 per cent in ET and 52 per cent of IMF. The presence of JAK2 V617F mutation was associated with a higher haemoglobin level (P<0.05), a higher white blood cell count (P<0.01) and higher age (P<0.05). Interpretation & conclusion: The JAK2 V617F mutation was detected in 86 per cent of patients with CMPD disorders. Peripheral blood mutation screening for JAK2 V617F can be incorporated into the initial evaluation of patients suspected to have CMPD.