Curvularia eragrostidis, a new threat to large cardamom (Amomum subulatum Roxb.) causing leaf blight in Sikkim

Large cardamom (Amomum subulatum Roxb.) is now affected by several diseases caused by both viruses andfungi. At present, leaf blight is considered a major threat to cardamom cultivation in Sikkim. During the pasttwo decades, cultivation of the crop in this region has dropped by almost 60%. Hence, to quantify the severityof leaf blight damage and identification of the causal organism for the disease, a survey was conducted fromMay to August 2017 in different large cardamom growing regions of Sikkim. During this survey, a typicalsymptom of leaf blight was observed on cardamom leaves in many locations. The leaves with blights werecollected, surface sterilized, and inoculated on potato dextrose agar (PDA). The pathogen was isolated as pureculture, and on the basis of morphological and microscopic characteristics, the fungus was identified species ofCurvularia. Molecular characterization of the fungal isolate with ITS-rDNA partial gene amplification usinguniversal primers (ITS4 and ITS5), showed 100% similarity with Curvularia eragrostidis (family: Pleosporaceae). The fungal isolate and nucleotide sequence was deposited in National Fungal Culture Collection ofIndia (NFCCI), Pune and NCBI with accession numbers NFCCI 4541 and MN710527, respectively. This is thefirst report on the occurrence of C. eragrostidis pathogen causing leaf blight of large cardamom grown inSikkim.

Early education and clinical exposure on hand hygiene: a key for better compliance

Background: India is underperforming when it comes to compliance to hand hygiene. Early education on followed by regular hand hygiene audits can bring positive changes in infection control practices.Methods: Group I included the 3rd Semester MBBS students who had early education and training on hand hygiene and Group II included the post graduate residents who were exposed to Hand Hygiene later in their carrier were followed up for compliance of WHO Hand Hygiene moments for four months. Compliance among students and residents were observed and compared.Results: Compliance rate was more (40.4%) among medical students as compared to residents (17%). The After moments had a better compliance than Before moments among both students and residents. The difference in the compliance rate was statistically significant.Conclusions: Early clinical exposure of the students to any problem, is the key for better compliance thus explaining the better compliance rate among medical students. Better HH practice can bring down prevalence of Healthcare associated infection by multidrug resistant organism which is a major concern today.

Invasive Pneumococcal Infection In An Infant: A Case Report

Streptococcus pneumoniae is a major pathogen of humans, causing diseases such as pneumonia,bacteremia and meningitis. The authors report a case of pneumococcal septicemia with meningitis in an infant. The objective of reporting this case is to highlight the importance of blood culture for early diagnosis. Alertness and rapid diagnosis led to favorable outcome in our case.

Occurrence And Resistance Profile Of Nonfermentative Gram-Negative Bacilli In A Tertiary Care Hospital - A Therapeutic Concern

Aim: To isolate, identify and characterize the prevalence of non- fermenting gram negative bacteria (NFGNB) along with their antimicrobial resistance pattern among the patients attending a tertiary care Hospital in Meerut. Materials and Methods: The isolates of NFGNB obtained from various samples were identified by standard bacteriological technique and VITEK® 2 system (Biomerieux , France) . Antimicrobial susceptibility test was carried out to assess the resistance profile both by Kirby Baeur disk diffusion method and VITEK® 2 system (Biomerieux , France) . Result: Atotal of 16,296 clinical samples from the indoor and outdoor patients were processed in the bacteriology laboratory. Isolation rate of nonfermenters was 7.82% (1274/16296). Pseudomonas spp. was the predominant isolate (66.56%) followed by Acinetobacter spp. (27.16%). Other isolated non-fermenters were Burkholderia cepacia complex (BCC)(1.57%), Stenotrophomonas maltophila (0.86%), Sphingomona spaucimobilis (0.71%), Achromobacter xylosoxidans (0.16%), Ochrobactrum anthropic (0.16%). Conclusion: NFGNB are emerging as important opportunistic pathogens and are mostly resistant to commonly used antimicrobials. Therefore early diagnosis and initiation of appropriate antibiotic therapy would help in efficient management of patients and result in reduction of morbidity and mortality caused by these multi drug resistant organisms.

Candiduria: A Reliable Indicator Of Neonatal Candidemia ? An Experience In A Tertiary Care Hospital.

Background & Objectives: Candidemia is a significant cause of nosocomial mortality and morbidity in neonates. Prompt diagnosis and treatment is crucial. Non-albicans Candida (NAC) species are assuming an increasing role in nosocomial infections in neonates. The present study was carried out i) to identify and speciate the Candida isolates obtained from cases of neonatal candidemia and to assess the risk factors and clinical manifestations associated with it (ii) to evaluate if candiduria, can be considered as a reliable indicator of candidemia. Methods: The prospective cohort study included the blood samples from 527 clinically suspected cases of neonatal septicaemia which were subjected to automated culture and processed as per standard microbiological techniques. The urine samples from all the 527 neonates were processed by conventional method. Results: Frequency of neonatal candidemia in culture proven cases of septicemia was 30.1%. Low birth weight was the commonest risk factor, followed by prematurity. Non-albicans Candida (NAC) species were isolated from blood in 86.4% cases compared to Candida albicans in 13.6%. Candida glabrata was the predominant species. Overall, candiduria was found in 54.5% cases of neonatal candidemia with same species of Candida isolated both from blood and urine samples. Among the cases of candiduria, NAC species were isolated in 81.7% compared to C. albicans in 18.3%. Correlation between candiduria and candidemia was maximum (73.33%) in C. albicans followed by C. tropicalis (72.41%) and C. glabrata (55.81%). Conclusions: The present study highlights the emergence of NAC species as an important cause of neonatal candidemia from Meerut city: definitely a changing trend. Further, our study also highlights that candiduria may be considered as a reliable indicator of candidemia in neonates.

Identification and Antifungal Sensitivity Pattern of Candida Species Isolated from Various Oro-dental Conditions.

Background: Oral candidiasis is the most common oral opportunistic infection seen in immunocompromised patients. Apart from C. albicans the non albicans Candida species, which are less susceptible to the commonly used antifungal drugs are major etiological agent for candidiasis. Thus, in recent years there has been an increased interest in spectrum of infections caused by Candida species. However with the recognition, that Candida spp. differ in the production of virulence factor and sensitivity to antifungal agents, greater emphasis has been placed on identification of isolates up to species level. In the past identification of various species of Candida other than C. albicans has not been attempted in oral lesions. Methods: A total of 158 swabs were collected from oral cavity of patients having lesions suggestive of oral candidiasis. One swab was subjected for direct microscopy using Gram staining. The second swab was inoculated on two tubes of Sabouraud Dextrose agar (SDA) with antibiotics (Hi-Media). Results: Candida albicans though was the commonest species isolated. , NAC is also emerging as important opportunistic pathogens in oro-dental infections. Conclusion: In view of the changing pattern, it is strongly recommended that species identification and sensitivity test can help in much better treatment strategies, and thus, gain a good control over the disease.

Sphingomonas paucimobilis septicemia in a neonate: A rare case report.

Sphingomonas paucimobilis, a yellow‑pigmented, aerobic, glucose nonfermenting, Gram‑negative bacilli is a rare cause of human infection. It was first discovered as an infective agent in humans in 1977 and named Pseudomonas paucimobilis. It was renamed as S. paucimobilis in 1990 in accordance with phylogenetic data. S. paucimobilis is an aerobic bacterium found in soil and water; it is a rare cause of healthcare associated infections. S. paucimobilis can cause infections in healthy as well as immunocompromised individuals. At first, its colony looks like Gram‑positive bacilli colony, so by mistake it is discarded as contaminants. S. paucimobilis is an emerging pathogen and it should not be discarded as contaminants. Here, we report a case of S. paucimobilis bacteremia in a neonate who presented with respiratory distress.

Evaluation of phenotypic tests for detection of Klebsiella pneumoniae carbapenemase and metallo-beta-lactamase in clinical isolates of Escherichia coli and Klebsiella species.

Context: Carbapenemase production is an important mechanism responsible for carbapenem resistance. Aims: Phenotypic detection and differentiation of types of carbapenemase in carbapenem resistant Enterobacteriaceae is important for proper infection control and appropriate patient management. Settings and Design: We planned a study to determine the occurrence of Class A Klebsiella pneumoniae carbapenemase (KPC type) and Class B Metallo-β-lactamase (MBL type) carbapenemase in hospital and community. Materials and Methods: Clinical isolates of Escherichia coli and Klebsiella species and simultaneously evaluate different phenotypic methods for detection of carbapenemases. Results: It was observed that 20.72% clinical isolates of E. coli and Klebsiella spp. were resistant to carbapenem on screening of which, 14.64% were E. coli and 29.69% were Klebsiella spp. Using phenotypic confirmatory tests the occurrence of carbapenemase production was found to be 87.01% in E. coli and 91.51% in Klebsiella spp. using both modified Hodge test (MHT) and combined disk test (CDT) using imipenem-ethylenediaminetetraacetic acid. Conclusions: Both MBL and KPC type carbapenemases were seen among clinical isolates of E. coli and Klebsiella spp. CDT is simple, rapid and technically less demanding procedure, which can be used in all clinical laboratories. Supplementing MHT with CDT is reliable phenotypic tests to identify the class A and class B carbapenemase producers.

Extended spectrum beta lactamase producing Proteus penneri: A rare missed pathogen.

Indole negative Proteus species are invariably incorrectly identified as Proteus mirabilis, often missing out isolates of Proteus penneri. We report a case of extended spectrum beta lactamase producing and multidrug-resistant P. penneri isolated from pus from pressure sore of a patient of road traffic accident. Correct and rapid isolation and identification of such resistant pathogen are important as they are significant nosocomial threat.

Evaluation of phenotypic tests for the detection of AmpC beta-lactamase in clinical isolates of Escherichia coli.

Background: AmpC beta lactamases are cephalosporinases that confer resistance to a wide range of beta lactam drugs thereby causing serious therapeautic problem. As there are no CLSI guidelines for detection of AmpC mediated resistance in Gram negative clinical isolates and it may pose a problem due to misleading results, especially so in phenotypic tests. Although cefoxitin resistance is used as a screening test, it does not reliably indicate AmpC production. Materials and Methods: We planned a study to determine the occurrence of AmpC beta lactamase in hospital and community, clinical isolates of Escherichia coli and simultaneously evaluate different phenotypic methods for detection of AmpC beta lactamases. Results: It was observed that 82.76% isolates were ESBL positive and 59% were cefoxitin screen positive. Using phenotypic confi rmatory tests the occurrence of Amp C beta lactamases was found to be 40% and 39% by inhibitor based method using boronic acid (IBM) and modifi ed three dimensional test (M3D) respectively. Conclusion: Both the test showed concordant result. Co-production was observed in 84.62% isolates Screening of ESBL and Amp C can be done in routine clinical microbiology laboratory using aztreonam and IBM respectively as it is a simple, rapid and technically less demanding procedure which can be used in all clinical laboratories.

Prevalence of HIV, Hepatitis B and Hepatitis C infection in Thalassemia major patients in tertiary care hospital, Gujarat.

Background: Children suffering from beta thalassemia major, due to various genetic defects, have deficient synthesis of ß globin chain of Hemoglobin. This leads to severe anemia, general fatigue and debility asking for repeated or frequent blood transfusion. On the other hand repeated blood transfusions such expose them to dangerous infections such as HIV, HBV and HCV. Aim: The aim of this study was to determine the prevalence of HIV, HBV and HCV infection among thalassemia major patients in an apex tertiary care hospital of Gujarat in west India. Materials and methods: Data were obtained from 100 ß thalassemia major patients attending thalassemia clinic for blood transfusion at regular interval in an apex tertiary care hospital of Gujarat between April 2008 and September 2008. Their laboratory results were subsequently analyzed. Results: Out of 100 patients 65 and 35 were male and female respectively. 18 (18%) patients were found Anti HCV Ab positive, 6 (6%) were found HBsAg positive and 9(9%) patients were Anti HIV 1 and or 2 Ab positive. Older age, more number of transfusions were associated with increased chances of the test to come positive suggestive of infection with respective virus. Completion of vaccination against HBV, completely or partially, was associated with less chances getting infection with HBV Conclusion: The prevalence of HCV infection is much higher compared to HBV and HIV infection due to possibly infected blood transfusion among thalassemia major patients. Screening of Anti HCV Ab detection with highly sensitive and specific test for donated blood is mandatory. Techniques like P24 Antigen detection or RT-PCR should be introduced to shorten the window period for detection of HIV infected donated blood.

Physician accessories: Doctor, what you carry is every patient's worry.

Background: Nosocomial infections are on the rise worldwide and many a times they are carried by the health care personnel. Accessories used by physicians and healthcare personnel can be a potential source of nosocomial infection. Materials and Methods: We designed a survey with the aim to investigate the prevalence of microbial flora of accessories such as pens, stethoscopes, cell phones and white coat used by the physicians working in a tertiary care hospital. Observations: It was observed that 66% of the pens, 55% of the stethoscopes, 47.61% of the cell phones and 28.46% of the white coats used by the doctors were colonized with various microorganisms. Staphylococcus spp. was the predominant isolate followed by Escherichia coli. Methicillin resistance in Staphylococcus aureus was also found, which was a matter of concern. Conclusions: Awareness of appropriate hand hygiene is important in order to prevent potential transmission to patients.

Bacteriology of infected deciduous root canal :a review.

The vast majority of diseases of the dental pulp & the periradicular tissues are associated with micro-organisms. A thorough understanding of these organisms & their relationship to clinical symptoms is necessary to formulate a sound approach to deciduous root canal therapy. This review article intends to highlight the microflora of infected deciduous root canal.

Beta-lactamase producing Pseudomonas aeruginosa in hospitalised patients.

Beta lactamase continues to be the leading cause of resistance to beta lactam antibiotics in gram-negative bacteria. A total of 50 clinical isolates of Pseudomonas aeruginosa were studied to determine the prevalence of ESBL production in hospital strains and also to study their susceptibility to various other antimicrobial agents. ESBL production was observed in a total of 18/50 (36%) of cases. Most of the ESBL positive isolates showed resistance to 3rd generation cephalosporins including multidrug resistance (MDR) to antibiotics like piperacillin, nalidixic acid, ciprofloxacin, levofloxacin, gentamicin and tobramycin. The ESBL producers however showed good susceptibility to drugs like meropenem, gatifloxacin and amikacin.

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.