ABSTRACT
Background & objectives: The two major genotypic markers that distinguish community acquired (CA) from hospital acquired (HA) methicillin resistant staphylococcus aureus (MRSA) isolates are the architecture of mobile genetic element (SCCmec type) and presence of panton valentine leukocidin (PVL) toxin. This study was conducted to determine the molecular characteristics of CA- and HA- MRSA and methicillin sensitive S. aureus (MSSA) isolates in Sikkim. Methods: A total of 150 clinical isolates of S. aureus isolated from various clinical specimens were subjected to duplex (mec-A and pvl gene) and multiplex (SCCmec typing) PCR. Results: of the 150 isolates, 53 (35.33%) and 66 (44%) were positive for mec-A (MRSA) and pvl genes, respectively. Thirty eight (25.33%) met the definition of CA-MRSA and 15 (10%) of HA-MRSA and the remaining 63 (42%) and 34 (22.66%) as CA- and HA-MSSA, respectively. No significant difference was seen in the distribution of PVL toxin in MRSA and MSSA isolates, but it was significantly (P<0.001) high in overall MRSA isolates than in MSSA. The majority of the MRSA isolates showed a double amplification band of SCCmec type III plus V (54.71%), and only a fewer isolates were amplified by single DNA fragments of type I (1.88%), III (3.77%), IVa (1.88%) and V (11.32%). SCCmec types I, III, IVa, were found only in HA-MRSA isolates, whereas type V in both the CA- and HA-MRSA. AST pattern showed that 18.42 per cent (7/38) and 46.66 per cent (7/15) were multidrug resistant (MDR)-CA-MRSA and MDR-HA-MRSA, respectively. Interpretation & conclusions: The present results show that SCCmec type V MRSA has been on the rise, and genotypic markers such as pvl gene detection used for the differentiation of these clinically distinct isolates of MRSA may not be reliable.
ABSTRACT
Background: Disease burden of acute febrile illness due to infectious etiologies is under reported in various parts of India including Sikkim due to lack of laboratory confirmation. Undifferentiated febrile illnesses common in tropical areas of Asia are dengue, chikungunya, malaria, leptospirosis, enteric fever, chikungunya, rickettsia, Japanese encephalitis and scrub typhus. Aims: This study was conducted to determine various infectious etiologies of acute febrile illness with their clinical presentations, complications and mortality with special emphasis to scrub typhus. Setting and Design: This was a cross-sectional study and 205 patients including paediatric patients admitted with acute febrile illness were evaluated. Materials and Methods: A detailed history was taken and complete physical examination was done in all patients. Basic laboratory tests were done in all cases along with confirmatory tests. Results: In our study the most common cause of acute febrile illness was found to be scrub typhus 74(36.1%) followed by dengue 25(12.2%), malaria10 (4.9%) and enteric fever 10 (4.9%). Sikkim is non endemic state for filariasis and visceral leishmaniasis. Interestingly in our study we found 2 cases (0.97%) of visceral leishmaniasis and 1(0.5%) case of filariasis. Conclusions: Scrub typhus was observed to be the common cause of acute febrile illness during the study period. Lack of diagnostic facilities makes scrub typhus an under-recognised cause of acute febrile illness in several parts of India even today. Although previously reported as occasional solitary cases from this region, this study witnessed the emergence of dengue as an outbreak in this region. Prompt recognition of acute febrile illness is important for specific treatment and better outcome in patients.
ABSTRACT
AIMS AND OBJECTIVES: The etiological spectrum of any superficial mycosis is largely dependent on the flora in the immediate environment of the individual. It is influenced by the geographic, climatic and occupational factors. The study is basically to formulate baseline data for the species prevalence of various dermatophytes in patients with onychomycosis attending the Central Referral Hospital, Gangtok, Sikkim. MATERIALS AND METHODS: Thirty-four clinically suspected cases of onychomycosis were subjected to mycological studies. RESULTS: Thirty-two (94.12%) cases were positive for fungal elements by direct microscopy and 28 (82.35%) by culture. Young adults in the age group of 21-30 years were mainly affected. The male:female ratio was 1.125:1. Dermatophytes were isolated in 18 cases (64.29%). Trichophyton tonsurans (44.44%) was the most common isolate followed by T. mentagrophytes (22.22%), T. rubrum (11.11%), T. verrucosum (11.11%) and Microsporum audouinii (11.11%). Apart from dermatophytes, Aspergillus niger (21.43%) and Penicillium marneffei (14.28%) were also isolated. CONCLUSION: Dermatophytes, mainly T. tonsurans, as well as moulds other than dermatophytes were isolated from onychomycosis patients in Gangtok, Sikkim.