Comparative Evaluation of Rose Bengal Plate test and ELISA in lab Diagnosis of Human Brucellosis

Human brucellosis is a major bacterial zoonosis reported worldwide. It is mainly an occupational disease reported in farmers, veterinarians, slaughterhouse workers, animal handlers and meat inspectors. Unavailability of automated blood culture systems makes isolation difficult and diagnosis mainly depends on serological and molecular methods. Materials and Methods: In a prospective study, a total of 127 serum samples, 28 from pyrexia of unknown origin (PUO) cases and 99 from high risk cases like veterinary personnel, butchers, nomads, farmers and gawalas, were serologically tested by Rose Bengal Plate Test (RBPT) and enzyme-linked immumosorbent assay (ELISA) and results were analyzed. Results: Out of 127 samples, 20 were tested positive by RBPT while 24 tested positive by ELISA. None of the PUO cases and veterinary personnel tested positive by RBPT or ELISA. Positivity was more among males, urban area, history of animal contact and consumption of raw milk. ELISA was found to be more sensitive and specific than RBPT. Conclusion: In our study significant prevalence of brucellosis was found among occupationally exposed persons. Most of the positive cases were found to be asymptomatic and those who were symptomatic had non-specific complaints. The findings signified silent presence of disease in our society. RBPT can be used as a rapid screening test in the peripheral resource poor labs and in absence of culture ELISA can be used for further confirmation.

Correlation between CRP and Blood Culture in Evaluation of Neonatal Sepsis

Ideal diagnosis and treatment strategies are difficult to define for Neonatal Septicemia and vary across the institutions. Clinical diagnosis is difficult because of early non-specific features. Mortality and morbidity due to sepsis can be prevented with early diagnosis and rational timely management. Non specific markers include CRP, leucopenia, Absolute Neutrophil Count, micro ESR (µ-ESR) , Procalcitonin etc. Amongst these CRP is easily available at many labs and is cost effective. Blood culture is considered as gold standard for diagnosis but it is costly and time consuming. Therefore, present study was done to compare and evaluate the CRP results with the blood culture reports and to provide a feasible, rapid and a relative economic method to diagnose neonatal septicemia. Methods: This Prospective Observational Study was done in the Pediatrics and Microbiology Departments of Government Medical College, Amritsar from 1st January 2017 to 31st December 2017. 270 neonates admitted with clinical suspicion of neonatal sepsis were included in this study. Neonates who received antibiotics prior to admission, with alternative diagnosis and/or with congenital malformations were excluded from the study. Blood culture was sent before starting antibiotics. CRP was done qualitatively by rapid slide latex agglutination method. Data analysis was carried out using computer software IBM SPSS and a p value of <0.05 taken as statistically significant. Results: We observed that 50.74% cases of neonatal sepsis were culture positive. CRP came out as a good predictor of sepsis with sensitivity, specificity, PPV, NPV and diagnostic accuracy of 83.9%, 34.5%, 56.93%, 67.64% and 66.78% respectively. Conclusion: Serum CRP can therefore be employed as a rapid screening test for neonatal sepsis.

To Study the Prevalence of Clostridium Difficile in Cases of Antibiotic Associated Diarrhoea in a Tertiary Care Hospital in North India

Clostridium difficile is a gram positive spore forming bacilli which can be normally present in human colon in some individuals. It can cause clostridium difficile infection which can lead to Clostridium difficile associated disease(CDAD) which is manifested by diarrhoea and in fulminant cases by pseudomembranous colitis and can lead to death. Disruption of normal intestinal flora by antimicrobials and lowering of immunity leads to its overgrowth and disease manifestations. Aims And Objectives: 1. To find the prevalence of clostridium difficile in stool samples of patients presenting with antibiotic associated diarrhoea. 2. To find the risk factors associated with the disease. Methods: The study was conducted from January 2017 to June 2018 on 131 stools samples of patients who developed diarrhoea after three days of starting antibiotics by ELISA based method for detection of Toxin A/B. Results: Out of 131 stool samples analysed, 6 samples (4.58%)were found to be positive for toxin A/B. Correlation between use of third generation cephalosporin and toxin positivity was found to be insignificant. Significant correlation was found between use of chemotherapeutic agents and toxin positivity. It was also found that advanced age was also significant risk factor for development of CDAD. Conclusion: The present study proves that Cdifficile should be kept in mind as an etiological agent in cases of antibiotic associated diarrhoea. Risk factors include advancing age, use of chemotherapeutic agents and antibiotic exposure. To prevent C difficile infection, unnecessary use of antibiotics should be stopped and screening of stools for Toxin analysis in cases of antibiotic associated diarrhoea should be done so that it can be diagnosed and treatment isstarted at the earliest.

Microbial Etiology and Antibiogram of SSIs following LSCS in a Tertiary Care Hospital in Amritsar

Surgical Site Infections (SSIs) are the second most commonly reported nosocomial infections after Urinary tract infection following a delivery by caesarean section. They add significantly to the morbidity, mortality and socioeconomic consequences in both patients as well as health care systems. Aim: To study the microbial etiology and antibiogram of post caesarean SSIs. Methods: This prospective study was conducted on pregnant women undergoing elective/emergency caesarean section irrespective of the indication during a study period from Jan 2017 to June 2018. 250 pregnant women undergoing LSCS developing signs and symptoms suggestive of SSI till the 30th post-operative day were included as cases. Under all aseptic precautions, two pus swabs were collected from every post caesarean women enrolled in the study. The first swab was used for gram staining while the other was inoculated on 5% blood agar and Macconkey agar. The isolates were identified by their colony characters and their standard biochemical tests. Antimicrobial susceptibility pattern was performed on Mueller Hinton agar plates by Kirby Bauer disc diffusion methods and interpreted as per latest CLSI guidelines. Results: Among 250 cases suspected of having SSIs, 93 aerobic isolates were obtained. Staphylococcus aureus (41.9%) was the most common organism isolated followed by Acinetobacter baumanii (15.1%), Escherichia coli(11.8%) Klebsiella pneumoniae(9.7%). 15/39(38.4%) of Staphylococcus aureus were observed to be Methicillin resistant. 15/45 (33.3%) of Gram negative isolates were Extended Spectrum Beta- Lactamase producers. Conclusion: Since MRSA is the leading cause of post caesarean SSI and the incidence of multidrug resistant pathogens as a cause of post-operative wound infections is rising with the increased prevalence of ESBL, therefore rational and judicious use of antimicrobials, active surveillance and reporting of SSI, enforcement of aseptic measures, implementation of infection control strategies and their periodic review is the need of an hour to reduce the rate of post caesarean SSIs.

Bacteriological profile of surgical site infections

Background: The susceptibility and severity of Rheumatoid arthritis are determined by both genetic and environmental factors. Dermatoglyphic patterns of individuals which are formed early in the fetal life are also determined by both genetic and environmental factors. Since both are genetically acquired and environmentally modified, it has been shown that there are particular dermatoglyphic patterns associated with Rheumatoid arthritis. If it is so, dermatoglyphics can serve as an additional tool in the early diagnosis and management of such a disabling disease like rheumatoid arthritis. Although there are some studies which mentioned dermatoglyphic pattern variation in the disease, the results are contradicting. Therefore, the present study was undertaken to find out a possible correlation of some quantitative and qualitative dermatoglyphic variables with Rheumatoid Arthritis. Aim of the study: To study the dermatoglyphic patterns in patients with Rheumatoid Arthritis and control population and to study the correlation between dermatoglyphic patterns and Rheumatoid Arthritis. Materials and methods: We studied 60 patients with Rheumatoid arthritis and 60 controls. All were subjected to detailed medical history and clinical examination. Both quantitative (finger ridge count and pattern intensity) and qualitative (fingerprint pattern) dermatoglyphic parameters were studied and the same were compared with age, sex and disease matched controls. Results: Out of the total 60 cases 12(20%) were male and 48(80%) were females. Of the total 60 controls, 12(20%) were males and 48(80%) were females. Analysis of the qualitative parameters revealed: Significant increase in the number of whorls in both the hands of female patients cases compared to the controls (p-value for right hand 0.001, p-value for left hand 0.004). The decrease in the number of radial loops in both the hands of male and female patients and the decrease was more in the left hand in males and right hand in females (p-value male left hand 0.002, female right hand Saritha K. Narayanan, Christopher C. Pais, Pradeep Kumar Shenoy. Use of palmar dermatoglyphics in rheumatoid arthritis - A case-control study. IAIM, 2017; 4(12): 70-76. Page 71 0.003). Decrease in the number of arches in the left hand of female patients compared to the controls (p-0.10). Analysis of the quantitative parameters showed: A statistically significant increase in the finger ridge count of individual hand and the total finger ridge count in both male and female patients compared to the controls (p-value males: right hand 0.003, left hand 0.004, right plus left hand 0.002; p-value females right hand.0000, left hand 0.000, right plus left hand 0.000). A statistically significant increase in the pattern intensity of fingers in female patients compared to the controls (p-value: right hand 0.006, left hand 0.001, right plus left hand 0.000). Conclusion: The findings of this work demonstrate the association between some of the qualitative and quantitative parameters of dermatoglyphics and Rheumatoid arthritis suggesting that dermatoglyphics can represent an anatomical, non-invasive, inexpensive tool for screening high-risk population and thus facilitate early detection and management.

A case report of Ludwig’s angina.

Ludwig angina is a rapidly progressing submaxillary, submandibular, and sublingual necrotizing cellulitis of the floor of the mouth that can have lethal consequences due to airway obstruction Various aerobic and anaerobic microorganisms, and less often fungi, have been implicated to cause Ludwig angina, including oral flora such as Streptococci and Staphylococci. Early recognition and use of parenteral antibiotics can prevent mortality and morbidity. We report a case of 30 years old male who was admitted to hospital with chief complaints of neck swelling, toothache, dysphagia and difficulty in opening mouth. Blood counts showed leukocytosis with neutrophilia along with raised ESR. Pus was drained after incision in submental and submandibular space and was transported to Microbiology department for further processing. Gram staining of pus showed many pus cells, spirochetes and fusiform shaped bacilli.

Prevalence of Nonfermentative Gram Negative Bacilli In Seriously ill Patients With Bacteraemia.

Bacteraemia due to nonfermentative gram negative bacilli appears to be increasing in frequency particularly in hospitalized patients with severe underlying illness. A total of 159 (79.50%) organisms were isolated from blood cultures of 200 seriously ill patients. Out of these, 73 (45.91%) were nonfermentative gram negative bacilli. Pseudomonas aeruginosa was the commonest isolate (32.88%) followed by Acinetobacter spp. (23.28%) and Burkholderia cepacia (10.96%). Analysis of antimicrobial susceptibility testing showed multidrug resistant pattern with majority of the isolates being resistant to three or more drugs.

Cellphones A Modern Stayhouse For Bacterial Pathogens.

Cellphones are increasingly used by health care personnels for communication. These can harbour various potential pathogens and become an exogenous source of nosocomial infections. A total of 160 cellphones belonging to doctors and paramedical staff working in various departments at govt. medical college and hospital, Amritsar were screened for bacterial isolates. Sterile swabs moistened with nutrient broth were used to swab the front, back and the sides of the cellphones and were subjected to culture and sensitivity. The same procedure was repeated after decontamination with 70% iso propyl alcohol.Out of total 160 cellphones growth was obtained in 65(40.62%) cellphones. 31(19.37%) from clinical workers and 34(21.25%) from non clinical workers. Coagulase negative staphylococcus was the most commonly isolated organism.The efficacy of decontamination with 70% isopropyl alcohol was found to be 98% as only 5 cellphones showed growth after decontamination.It was found that around 40% of the cellphones of health care workers were contaminated and thus acted as a potential source of nosocomial infections. Simple measures like decontamination with 70% isopropyl alcohol was found to be 98% effective.

Bacterial Profile of Blood Stream Infections and Antibiotic Resistance Pattern of Isolates.

Blood samples from 2542 clinically diagnosed cases of septicemia were processed. Out of these 946 (76.55%) were from Pediatric Department and rest from other Departments. Growth was obtained in 509(20.02%) cases . Candida spp were isolated from 23 (4.57 ) cases Out of 486 bacterial isolates 52.67 % were gram positive bacteria whereas 47.33% were gram negative bacilli . Staph aureus 133 (27.37%)was the predominant organisms followed by CONS 98 (20.1%). Amongst gram negative organisms Enterobacter 69 (14.19 %) was the most predominant followed by Esch coli 45 (9.27 %) Pseudomonas 37 (7.62 %) and Acinetobacter spp 34 (6.69 %). Amongst gram positive organisms maximum resistance was seen with ampicillin (74.61%) and erythromycin (69.67 %). Most of the gram negative bacilli were MDR (71%). Maximum resistance was observed with ampicillin (86.1% ) cephalexin (68.07%) and piperacillin (57.71%). Most successful drugs were amikacin,gentamicin and cefotaxime. 34.35% of the isolates were ESBL producers.