Simultaneous detection of dengue NS1 antigen, IgM plus IgG and platelet enumeration during an outbreak

During 2010, there was an increase in dengue virus infections in New Delhi, India compared to 2009. This study was conducted at Sant Parmanand Hospital during this outbreak to determine the utility of a 'Dengue Package', comprising simultaneous detection of dengue non-structural protein 1 [NS1], anti-dengue IgM, anti-dengue IgG and platelet enumeration for early diagnosis, better case management and faster public health response. Blood samples were tested for Dengue NS1, IgM and IgG using the single-step immunochromatigrahic One-step dengue NS1 Ag and IgG/IgM test, while platelets were enumerated with automatic analysers yielding results within 1-2 hours. Of the 1,886 patients screened with the 'Dengue Package', 678 and 1208 were NS1-positive and -negative respectively, in different combinations. In 394 cases, NS1 was exclusively positive while 29 were also IgG positive. In 942 cases NS1, IgM and IgG were negative [triple negative]. The platelet counts in the NS1 positives were lower than the NS1 negatives, mean and standard deviation [SD] 116.8 +/- 70.2 x 109/L: 95% confidence interval [CI] 66.6-74.1 and 167.2 +/- 94.0 x 109/L, P<0.0001. Platelet counts were <20 x 109/L in 20 NS1 antigen-positives and 42 NS1 antigen-negatives. During the 2010 outbreak, swift availability of the 'Dengue Package' assisted patient management, platelet transfusions, implementation of anti-vector measures and public health notifications. Testing for NS1 assisted the diagnosis of an additional 22.4% cases; of these 394 had evidence of primary infection and 29 of secondary infection. The 'Dengue Package' was useful in tackling the rise in suspected cases

Tigecycline in-vitro susceptibility and antibiotics' fitness for gram-negative pathogens

To determine the tigecycline in-vitro susceptibility of naive gram-negative pathogens from serious infections in Delhi, India. During July to October 2007 investigations were carried out to determine the tigecycline in vitro susceptibility of 50 consecutive gram-negative pathogens from serious infections at the Sant Parmanand Hospital, Delhi, India. Minimum tigecycline inhibitory concentrations were determined employing the E test method [AB Biodisk]. Twenty-four percent of isolates were found to be tigecycline resistant or partly susceptible. Susceptibility of the isolates was lower than meropenem but similar to piperacillin-tazobactam, amoxicillin-clavulanic acid, and amikacin. Tigecycline resistance was prevalent in the gram-negative isolates from serious infections prior to its marketing in India. The choice of any recently marketed antibiotic for a pilot treatment against serious gram-negative infections should not be automatic. In the initial phase of its marketing, it should be evaluated in parallel with the antibiotics with excellent local susceptibility profiles

Infarction of spleen in typhoid fever

Ultrasonography and computed tomography scan with hypo echoic areas diagnosed a splenic infarction in a Salmonella typhi infected 30-year-old man with painful hypochondrium and epigastrium. An antibiotic recipe of ceftriaxone and amikacin resulted in recovery. Imaging techniques contribute remarkably to a rapid diagnosis and rational management of the extra intestinal lesions attributable to the Salmonella typhi/paratyphi group of organisms