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Abstracts: Background & Objective: Leptospirosis is an emerging infectious disease, for the diagnosis of which clinical, epidemiological and laboratory parameters may be evaluated as per modidified Faine’s criteria suggested by several authors. The objective of this study was to validate the utility of modified Faine’s criteria in the diagnosis of leptospirosis. Methodology: This study was carried out at a tertiary care hospital in Bengaluru, India from January 2011 to April 2012. Blood, urine and paired sera from one hundred patients with clinical suspicion of leptospirosis were collected. Relevant clinical and epidemiological details of these patients were also obtained as per modified Faine’s criteria. Blood and urine samples of these patients were subjected to Dark Field Microscopy (DFM) and culture, whereas, their sera were subjected to Immuno chromatography (IgM Leptocheck), IgM Enzyme Linked Immuno Sorbent Assay (IgM ELISA) and Macroscopic Slide Agglutination Test (MSAT). All the leptospira seropositive samples were subjected to Microscopic Agglutination Test (MAT) which was also used as the gold standard to validate all the aforementioned serological tests and modified Faine’s criteria. Results: Positive Predictive Values (PPV) of all the aforementioned serological screening tests and modified Faine’s criteria were calculated. PPV of IgM Leptocheck, MSAT, IgM ELISA and modified Faine’s criteria were found to be 14.3%, 6.5%, 8.7% and 21% respectively. Conclusion: The diagnosis of leptospirosis (both laboratory & clinical) is an uphill task. A high index of suspicion is needed in endemic areas & leptospirosis must be considered when a patient presents with acute onset of fever, headache & myalgia. From the results obtained in our study, it seems that modified Faine’s criteria may not be as useful a diagnostic tool as it has traditionally been thought to be. More studies should be carried out to evaluate its diagnostic utility.
ABSTRACT
Context: This study was conducted to analyze the clinical utility of various leptospira diagnostic modalities. Aims: To evaluate the role of dark field microscopy (DFM), culture, immunochromatography (IgM Leptocheck), IgM enzymelinked immunosorbent assay (IgM ELISA), macroscopic slide agglutination test (MSAT) and microscopic agglutination test (MAT) in diagnosing leptospirosis in febrile patients. Settings and Design: Descriptive study conducted in a tertiary care hospital from January 2011 to April 2012. Subjects and Methods: Blood, urine and paired sera from 100 patients with clinical suspicion of leptospirosis (study group) were collected and subjected to DFM, culture, IgM Leptocheck, IgM ELISA and MSAT. Fifty randomly selected sera from febrile patients tested positive for infections other than leptospirosis (control sera) were also subjected to the aforementioned serological assays. All the leptospira seropositive samples were subjected to MAT. Statistical Analysis Used: Positive predictive values (PPV) and coefficient of agreement (kappa). Results: None of the clinical samples showed positivity by DFM. Leptospira inadai was isolated from a urine sample. The seropositivity of IgM Leptocheck, IgM ELISA and MSAT was 16%, 46% and 47%, respectively. The PPV of these assays was 14.3%, 8.7% and 6.5%, respectively. Poor agreement was obtained among these assays. Only four study group leptospira seropositive samples were confirmed by MAT with Australis being the predominant serovar. None of the leptospira-positive control sera were confirmed by MAT. Conclusions: DFM and culture have limited utility in diagnosing leptospirosis with serology being the mainstay. The present study shows discordant results with the commercially available serological kits. Further studies should be done to evaluate the various diagnostic modalities.
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Background: A novel swine origin influenza virus (H1N1) is spreading worldwide and threatens to become pandemic.H1N1 critical illness mostly affects young patients and is often fatal. Aim: The aim of the present study is to evaluate the clinical characteristic of H1N1 infection in a tertiary care hospital. Materials and Methods: A total of 92 nasal and pharyngeal swabs from suspected cases of swine flu were processed by real time reverse transcriptase polymerase chain reaction (rRT-PCR). Result: Twenty(21.73%) were positive of which two were treating physicians and five (25%) patients expired. Conclusions: The age group of positive cases of H1N1 was between 21 and 30 years and age group of patients who died ranged from 40 to 45 year. This overview indicates that although the majority of hospitalized persons infected with novel influenza A (H1N1) recovered without complications, certain patients had severe and prolonged disease. It was also noted that 2009 influenza A (H1N1) infection - related clinical illness predominantly affects young patients. All hospitalized patients with novel influenza A (H1N1) infection should be monitored carefully and treated with antiviral therapy. Mandatory vaccination of health-care workers is especially important in emerging pandemic.
ABSTRACT
Enterococcus, considered a normal commensal of intestinal tract, is fast emerging as a pathogen causing serious and life threatening hospital borne infections. This is attributed to acquisition of multi drug resistance and virulence factors of the organisms. The sequencing of Enterococcus faecalis has given a lot of insight into its genetic makeup. The E. faecalis strain V583, which has been sequenced, contains a total of 3182 open reading frames (ORFs) with 1760 of these showing similarity to known proteins and 221 of unknown functions. Strikingly unique to this genome is the fact that over 25% of the genome is made up of mobile and exogenously acquired DNA which includes a number of conjugative and composite transposons, a pathogenicity island, integrated plasmid genes and phage regions, and a high number of insertion sequence (IS) elements. This review addresses the genomic arrangement and the study of virulence factors that have occurred since the sequencing of the genome.