A fulminant case of acute respiratory distress syndrome associated with Mycoplasma pneumoniae infection.

Acute respiratory distress syndrome (ARDS) caused by mycoplasmas is very rare. This report describes a severe case of atypical pneumonia due to M. pneumoniae in a formerly healthy young woman who developed high grade fever and cough leading to severe disseminated lung disease and finally to fatal ARDS. This case came into picture when killer atypical pneumonia, namely, SARS (severe acute respiratory syndrome), spread very fast from South-Asian countries to the rest of the world. Moreover, the clinical presentation and radiologic features of SARS bear resemblance to the syndrome of atypical pneumonia, which lead us to investigate this case into detail. We suggest that M. pneumoniae infections should be included in the differential diagnosis of pathogens causing ARDS, establishing an early diagnosis may have important therapeutic implications.

Guillain-Barré syndrome: association with Campylobacter jejuni and Mycoplasma pneumoniae infections in India.

BACKGROUND: Guillain-Barré syndrome is the most common cause of acute neuromuscular paralysis and is considered a post-infectious disease. METHODS: Twenty patients with Guillain-Barré syndrome admitted to the Neurosciences Centre at the All India Institute of Medical Sciences from November 1997 to August 1998 were investigated for evidence of antecedent infections. This case-control study included 2 controls for each patient, one a household control and the other an age- and sex-matched hospital control suffering from a neurological illness other than Guillain-Barré syndrome. Evidence of recent Campylobacter jejuni infection was investigated by culture and serology, and for Mycoplasma pneumoniae by serology. RESULTS: There was evidence of recent C. jejuni infection in 35% of the patients compared with 25% of household controls and none of the hospital controls. M. pneumoniae infection was seen in 50% of patients compared with 25% of household controls and 15% of hospital controls. About one-third of the patients (30%) had evidence of both infections. The association of both infections in patients was found to be statistically significant as compared to hospital controls. CONCLUSION: C. jejuni and M. pneumoniae may be important antecedent illnesses in patients with Guillain-Barré syndrome in India.

Molecular typing of Salmonella enterica serotype Worthington isolates from infantile diarrhoea.

BACKGROUND AND OBJECTIVES: Salmonella Worthington has been known to be a causative agent for childhood diarrhoea. There is a paucity of information on the molecular relatedness of the strains isolated in various hospitals in India. The present study was carried out to attempt molecular typing of a cluster of Salmonella Worthington isolates obtained from cases of infantile diarrhoea during a six month period, from a tertiary care paediatric hospital in Delhi, India. METHODS: Nine isolates of S. Worthington obtained from faecal samples of infants suffering from diarrhoea during October 2001 to March 2002, were identified by the conventional biochemical methods and by serotyping. The antimicrobial susceptibility was determined by the disk diffusion method. Molecular typing was done by ribotyping. RESULTS: Eight patients were admitted to 3 different wards of the hospital and one was an outpatient. Four patients including the first patient visited the hospital with diarrhoea as the presenting symptom while five developed diarrhoea after admission. Stool microscopy showed no specific findings. Salmonella Worthington was isolated from stool cultures of these patients. Repeated cultures of the common drinking water source of the hospital and the milk supplied to children from central kitchen were negative for known pathogens. All S. Worthington isolates were resistant to all the beta-lactams tested including third generation cephalosporins. Eight isolates were sensitive to furazolidone and 6 to ciprofloxacin. Molecular characterization by ribotyping revealed four different clones. INTERPRETATION AND CONCLUSION: As four different ribotypes of the isolated Salmonella Worthington isolates were identified, it was clear that there was no single source of infection.

Microbiological profile of neonatal septicemia in a pediatric care hospital in Delhi.

Septicemia continues to be an important cause of morbidity and mortality in the neonatal units and periodic review of cases to assess any changing trends in the infecting organisms and their antimicrobial susceptibility is important. Over a period of one year (July 2000 to June 2001), 632 samples of blood cultures were submitted to the bacteriology laboratory Microbiology, Lady Hardinge Medical College. These samples were investigated for microbial etiology and the isolates obtained were tested for their susceptibility to the commonly used antibiotics. Twenty per cent (125) cases were culture positive. Gram-negative bacteria were the predominant isolates (62%), commonest being Klebsiella pneumoniae (34%) followed by E. coli (17%), Acinetobacter spp. (9%) and Enterobacter aerogenes (2%). Gram-positive cocci were isolated in 20% cases, of which coagulase negative staphylococcus was the predominant isolate (11%) followed by Enterococcus spp. (5%) and S. aureus (4%). Candida spp. was isolated from 18% of cases. Resistance to commonly used antibiotics was seen in more than 35% of isolates. An alarming observation was the very high incidence of resistance to amoxycillin+clavulanic acid and ceftriaxone (>80%). All isolates showed highest susceptibility to ciprofloxacin.

Acute lower respiratory tract infection due to Chlamydia species in children under five years of age.

BACKGROUND: The contribution of Chlamydia spp in respiratory tract infections in paediatric population from India has not been studied in detail. METHODS: Sixty children under five years of age who were admitted with acute lower respiratory tract infection during a one year period were investigated for Chlamydial aetiology of respiratory infection. Diagnosis was based on antigen detection by direct immunofluorescence (DIF) in throat swab along with anti-Chlamydial immunoglobulin G (IgG) antibody demonstration by solid phase enzyme immunoassay (EIA). RESULTS: Chlamydia spp antigen was detected in seven (11.6%) cases, C. pneumoniae in six (10%) and C. trachoniatis in one (1.6%). Chlamydia spp IgG antibody in serum was demonstrated in 24 (40%) cases, of which C. pneumoniae IgG was denconstrated in 18 (30%) cases. Taking the criteria of antigen detection (n=7) and high IgG antibody titre of > or = 1:512 (n=5) for a positive case, 12 (20%) children were found to be suffering from recent Chlamydial infection. CONCLUSION: Chlamydia spp plays a significant role in respiratory tract infections in Indian paediatric population. Diagnostic procedure like antigen detection in throat swab is rapid, less cumbersome and feasible and should be more widely used along with antibody demonstration to determine the aetiological agent early in the course of illness.

Malaria, leprosy and dapsone.

Although the preventive action of dapsone against P. falciparum malaria was known for many years, there was no report about the incidence of P. falciparum malaria in leprosy patients treated with dapsone, especially from areas of Southeast Asia where both leprosy and malaria are endemic. Therefore, two clinic-based malaria surveys were undertaken at a gap of 12 years, comprising 506 lepromatous leprosy patients and 499 febrile nonleprosy control subjects. Both the surveys showed that the lepromatous patients treated with MDT had only P. vivax malaria (incidence comparable to the febrile nonleprosy controls) with complete freedom from P. falciparum. On the contrary, control sujects not taking any-leprosy drugs and staying with the leprosy patients at the same beggars' home, had both P. vivax and P. falciparum malaria. It is postulated that dapsone provided protection against P. falciparum among leprosy patients.