Aetiology of hospital-acquired diarrhoea in under-five children from an urban hospital in East Delhi, India

Background & objectives: Majority of the studies of hospital-acquired diarrhoea conducted in Western countries have focused on the detection of Clostridium difficile in stool samples. Limited Asian and Indian literature is available on hospital-acquired diarrhoea. This study was aimed to describe the aetiological profile for hospital-acquired diarrhoea in children aged below five years. Methods: One hundred children aged one month to five years who developed diarrhoea (?3 loose stools for >12 h) after hospitalization for at least 72 h were enrolled. Children who were prescribed purgatives or undergoing procedures such as enema and endoscopy or those with underlying chronic gastrointestinal disorders such as celiac disease and inflammatory bowel disease were excluded from the study. Stool samples from the enrolled children were subjected to routine microscopic examination, modified Ziel- Nielson (ZN) staining for Cryptosporidium and culture for various enteropathogens. Multiplex PCR was used to identify the strains of diarrhoeagenic Escherichia coli. Rotavirus detection was done using rapid antigen kit. Toxins (A and B) of C. difficile were detected using enzyme immunoassay. Results: Of the 100 samples of hospital-acquired diarrhoea analysed, diarrhoeagenic E. coli (DEC) was found to be the most common organism, detected in 37 per cent of cases (enteropathogenic E. coli-18%, enterotoxigenic E. coli-8%, enteroaggregative E. coli-4% and mixed infections-7%). Cryptosporidium was detected in 10 per cent of cases. Rotavirus was detected in six per cent and C. difficile in four per cent of cases. Interpretation & conclusions: The findings of this study suggest that the aetiological profile of hospital- acquired diarrhoea appears to be similar to that of community-acquired diarrhoea, with DEC and Cryptosporidium being the most common causes. The efforts for the prevention and management of hospital-acquired diarrhoea should, thus, be directed towards these organisms.

Oral health status and microbial load of Streptococcus mutans in children with Cerebral palsy in a tertiary care hospital in Delhi

Background: Cerebral palsy (CP) is a childhood debilitating condition which impairs the physical and mental ability of an individual to maintain oral health. Aim: The objective of the present study was assessment of dental neglect and burden of treatment needs of children affected with CP as compared to normal children in a tertiary care hospital in Delhi. Settings and Design: A sample size of 104 children of age group of 6–14 years was selected, in which 52 children of CP (case group) and 52 normal school children (control group) were recruited. Materials and Methods: Children from both groups were examined, and calculation of drug master files (DMFS), defs, oral hygiene index (OHI), and gingival index was done. The presence of trauma and malocclusion was assessed. Present caries activity was assessed by the level of Streptococcus mutans present in saliva in both groups. Treatment needs were then assessed based on intraoral findings. Statistical Analysis: Data were analyzed by SPSS 20.0 software. Student's t-test and nonparametric statistical tests such as Chi-square test and Mann–Whitney test were used as per the nature of variables studied for statistical analysis with the level of significance denoted at P < 0.05. Results: The mean DMFS, gingival index, OHI, and treatment needs were observed to be higher in the CP group. Increased S. mutans levels were observed in saliva of CP patients. Defs score, trauma, and malocclusion were not statistically significantly higher in CP group as compared to the control group. Conclusion: Cerebral palsy group had a poor oral and gingival health, a higher DMFT and burden of treatment needs and an increased risk of further caries progression due to high caries activity indicated by increased level of salivary Streptococcus mutans than the control group.

A prospective cohort study of enteric pathogens in human immunodeficiency virus-infected Indian children and their relationship with diarrheal recurrence

Background: Opportunistic intestinal infections can increase the risk of death 11- fold in Human immunodeficiency virus (HIV) infected children presenting with diarrhea. Understanding the etiology of diarrhea and its predictors can help strategize a targeted approach to reduce child mortality due to diarrhea in this vulnerable group. Authors aim was' to compare the enteric pathogens in HIV-infected children with and without acute diarrhea, to assess the association between carriage of enteric pathogens in HIV-infected children and the occurrence of diarrhea within the next 3 months and to ascertain the relationship between enteric pathogens in HIV-infected children with their immunological and nutritional status.Methods: Stool samples were collected from HIV-infected children with acute diarrhea (n=41) and without diarrhea (n=52). All samples were subjected to microscopic examination, modified acid-fast and Trichrome staining, hanging drop examination, and bacterial culture. Serology for Cryptosporidium parvum was determined. Children who had received any antimicrobial therapy within the previous 2 weeks were excluded. Participants were followed up for three months for occurrence of diarrhea.Results: Intestinal pathogens were isolated in 48.8% and 42% of children in the diarrheal and non-diarrheal group respectively. The most common pathogens isolated in the diarrheal and non-diarrheal group were Cryptosporidium parvum and Escherichia coli (29.3% vs. 17.3%). During follow up, 8 children in each group had diarrheal occurrence. The pathogen isolated in subsequent episodes matched with the initial isolate in 3 children in each group.Conclusions: HIV-infected children without diarrhea also harbour enteric pathogens in comparable proportions to symptomatic children, which can predispose them to diarrheal occurrence in future, hence indicating need for assessing the need for preventive screening and prophylactic antibiotic regimens in this vulnerable group.

Molecular detection of Plasmodium falciparum and Plasmodium vivax prevalence in North Indian population

Currently, malaria ranks as the 5th major cause of death in developing countries. There are six human malarial parasites species, with Plasmodium falciparum (Pf) and P. vivax (Pv) being the most predominant. This study enrolled 165 outpatients of a tertiary care hospital of the northeast district of Delhi. Blood samples were taken and were examined for malaria by slide microscopy and rapid malarial antigen detection test. DNA extraction was done and PCR was performed for genus as well as species identification. A total of 60 (36.36%) malaria positive samples were identified among a total of 165 samples collected. P. vivax and P. falciparum were found to be present in 51.66 and 13.33% samples, respectively and 18.33% samples were positive for both the species on the basis of PCR analysis. The present study suggests that while the traditional methods for diagnosis of malarial infection are gold standard they will not be able to detect mixed infections with low parasite count

Application of a stool antigen test to evaluate the burden of Helicobacter pylori infection in dyspepsia patients.

Helicobacter pylori (HP) is causally associated with peptic ulcer disease and gastric carcinoma. Determination of the prevalence of HP infection in dyspepsia patients’ in particular geographical area is imperative for the appropriate management of dyspepsia. HP antigen detection in stool is a noninvasive diagnostic test of HP infection. This prospective study was conducted to find out the prevalence of HP infection based on stool antigen testing in dyspeptic patients who had also undergone upper gastrointestinal (GI) endoscopy. This study highlights the high prevalence of HP infection in dyspeptic Indian patients, particularly males, and emphasizes the growing importance of the bacterium causing infection among children. We also found HP stool antigen testing to be superior to upper GI endoscopy for detecting HP infection. Hence, we recommend initial testing for HP stool antigen in dyspeptic patients before initiating treatment and before carrying out any invasive procedure such as endoscopy.

Vaccines for fungal infections

High morbidity and mortality caused by mycotic infections has been a cause for concern. Trials for various vaccines against fungal pathogens have not been approved by the US Food and Drugs Administration because of the high cost of production and lack of a single suitable candidate. Most fungal infections require cell-mediated immunity for their clearance. This has been the basis for the development of various vaccines. We discuss the various trials of candidate vaccines, the protective efficacy as well as their shortcomings. Recent research suggests that a universal vaccine can be prepared which may be effective against most fungal pathogens.

Cryptosporidium in Children with Diarrhea: A Hospital-based Study.

Objective: To estimate the proportionate contribution of Cryptosporidium to diarrhea in under-five children, and to study its demographic and clinical associates Methods: We collected stool specimens from children (age <5 yrs) suffering from diarrhea. The specimen was examined on the same day by Kinyoun’s acid-fast staining for the presence of Cryptosporidium parvum oocyst; rest of the sample was preserved for later cryptosporidium antigen detection by commercially available ELISA kit. Results: Out of 175 children with diarrhea, 48 (27.4%) had Cryptosporidium antigen in their stool specimen. Gender, history of contact with domestic animal, hydration status, breastfeeding and nutritional status were not significantly associated with cryptosporidium infection in children with diarrhea. Conclusion: Cryptosporidium is present in a significant portion of children suffering from diarrhea in our setting. Antigen detection has much higher isolation rate than acid-fast staining.

Pattern of Candida isolates in hospitalized children.

Nosocomial candidemia is the 4(th) most common pathogen in blood stream infection. Emergence of non-albicans Candida species with often intrinsically resistance fluconazole pattern may lead to difficulty in management of septicemia. Although the present study isolated 80% of non albicans candida species with C.tropicalis as the most common (35%) species, 96% of our Candida species isolated were sensitive to fluconazole. The probable causes of low resistance pattern to fluconazole in our institute are discussed. It is however necessary to identify the complete clinical response to the given treatment. Therefore, appropriate identification of species with susceptibility testing would be advisable before start of anti-fungals. This would prevent emergence of fluconazole resistance.

Trend of antibiotic resistance of Vibrio cholerae strains from East Delhi.

BACKGROUND & OBJECTIVE: Epidemics of cholera caused by toxigenic Vibrio cholerae O1 and O139 (Bengal strain) represent a major public health problem in most developing countries. In view of the reported shift in epidemiology and pattern of antibiotic resistance in this was study carried out to assess the development of resistance to essential drugs like fluoroquinolones during treatment of cholera and cholera like cases in Delhi. METHODS: Faecal specimens collected from 1184 patients with cholera and cholera like illness between 2001-2006 admitted to Guru Teg Bahadur hospital, East Delhi were subjected to culture isolation. Antimicrobial susceptibility testing of V. cholerae isolates was done by disc diffusion method. RESULTS: Of the 1184 faecal samples examined, 670 (56.6%) were positive for V. cholera from 2001- 2006. V. cholerae El Tor Ogawa (54.6%) was more common than serotype Inaba (32.5%). During 2004-2006 V. cholerae Inaba emerged as the predominant serotype. Resistance to nalidixic acid, furazolidone and co-trimoxazole was constantly high (100%). Multiple antibiotic resistance (MAR) V. cholerae O1 Inaba isolates exhibited increased resistance to ciprofloxacin with MIC >4 microg/ml, but largely all remained susceptible to other antibiotics like, gentamicin, tetracycline and chloramphenicol. INTERPRETATION & CONCLUSION: V. cholerae have a permanent existence in the environment and during the quiescent period, their survival in water bodies allows dissipation of resistance patterns to different serotypes or strains of V. cholerae O1 and therefore there is need for constant observation.

Mycological profile of infectious Keratitis from Delhi.

BACKGROUND & OBJECTIVE: Corneal blindness is a major health problem worldwide and infectious keratitis is one of the predominant causes. The incidence of fungal keratitis has increased over the last few years. Though a few studies have been carried out on mycotic keratitis from north and other parts of India, there are none from Delhi. Keeping this in mind, this study was conducted to evaluate the frequency of positive fungal cultures in infectious keratitis and of the various fungal species identified as aetiologic agents in patients attending a tertiary care hospital in East Delhi. METHODS: Corneal scrapings from 346 patients of corneal ulcer with suspected fungal aetiology were subjected to direct examination by 10 per cent KOH mount, Gram stain and culture. The results were examined retrospectively and analyzed. RESULTS: Of the 346 patients of corneal ulcer investigated, in 77 (22.25%) cases fungal aetiology was identified. Males were more commonly affected and were mostly in the age group of 31-40 yr. It was seen that trauma was the most common predisposing factor especially in the agriculturists and the farmers. Aspergillus flavus was the most common fungus isolated in 31.16 per cent cases, followed by A. fumigatus (16.88%) and Fusarium spp. (7.79%). Yeasts were also isolated in 21.62 per cent cases. Both yeasts and mycelial fungi were isolated in 6.5 per cent of cases. INTERPRETATION & CONCLUSION: Because of serious consequences of infectious keratitis, it is important to know the exact aetiology of corneal ulcer to institute appropriate therapy in time. Laboratory confirmation should be undertaken and fungal infection should be ruled out before prescribing corticosteroids and antibacterial antibiotics.

Phaeomycotic cyst--a case report.

Phaeomycotic cyst or subcutaneous phaeohyphomycosis is the most common type of phaeohyphomycosis. Fonsecaea pedrosoi as the causative agent of subcutaneous phaeohyphomycosis was earlier reported in India. Here a case of a patient of 22-year-old farmer is presented with a soft cystic swelling on the left wrist. Direct examination of the aspirate from the swelling showed dematiaceous hyphae. Culture grew Fonsecaea pedrosoi. The patient responded to antifungal therapy.