Study of Prevalence and Serodiagnosis of Dengue Fever in Febrile Patients Attending a Tertiary Care Hospital.

Dengue is a mosquito-borne viral infection found in tropical and sub-tropical regions around the world and has emerged as a significant threat and burden to public health systems. The infection is transmitted by the bite of an infected female mosquito- Aedes aegypti. Dengue viral infection may be asymptomatic or may give rise to undifferentiated fever with or without other associated clinical manifestations, namely, Dengue Fever (DF), Dengue Haemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS). The present study is conducted to evaluate the prevalence and serodiagnosis of Dengue fever among patients with acute febrile illness, provide useful guidance to clinicians for early diagnosis and prevention of untoward complications of dengueMETHODSThis was a retrospective descriptive study conducted for a period of one year in a tertiary care hospital from January 2019- December 2019. Blood samples collected from 1905 clinically suspected cases of dengue fever and serum were separated and tested for detection of Dengue NS1 antigen, Dengue specific IgM antibody and IgG antibody by using Dengue Day 1 test kit (procured from J. Mitra & Co. Ltd, India). Test was performed and results were interpreted as per manufacturer manual.RESULTSOut of 1905 serum samples tested, 273 were positive for dengue and 1632 were negative, with seropositivity was 14.33%. Out of 273 dengue positives, 202 (73.6%) were positives for dengue specific NS1 Antigen, 50 (18.3%) were positives for dengue specific IgM and 14 (5.12%) were positives for dengue specific IgG and 8 (2.93%) were positives for both IgM and IgG. Out of 273 positives cases of dengue, 158 (57.8%) were males and 115 (42.12%) were females. Majority of the patients tested positive were in the age group of 21-30 yrs. (28.2%).CONCLUSIONSDengue cases occur throughout the year with more positives in Jun-October. The incidence of dengue cases was higher in males and in children and in young adults. Early laboratory diagnosis of dengue fever among patients with acute febrile illness is essential to prevent dengue related complications.

The rising trend of coagulase‑negative staphylococci in neonatal septicemia.

Neonatal septicemia is one of the leading causes of neonatal mortality and morbidity worldwide. Hence, the present study was undertaken to isolate the bacteria causing neonatal sepsis and determine their antibiotic susceptibility pattern. Fifty neonates suspected to have septicemia were screened for 2 months (July and August 2014). Out of 50 specimen, 15 (30%) were blood culture positive. Coagulase‑negative staphylococci was the most common isolate (10, 66.6%), with 60% (6 isolates) methicillin resistance. In view of the increasing antibiotic resistance, periodic surveillance should be conducted to control the emergence and spread of antimicrobial resistance.

Association of Chlamydia pneumoniae IgG and IgA antibody in coronary artery disease.

Background: Cardiovascular disease, resulting from atherosclerosis, is a leading cause of global morbidity and mortality. Classical risk factors explain much of the attributable risk for cardiovascular events, but other risk factors for the development and progression of atherosclerosis, which can be identified, may be important therapeutic targets. Infectious agents, such as Chlamydia pneumoniae, have been proposed as contributory factors in the pathogenesis of atherosclerosis. The present study was conducted to determine the seroprevalence of C. pneumoniae antibodies and to study the association of chronic C. pneumoniae infection with Coronary Artery Disease (CAD). Methods: The study group included 90 angiographically proven CAD patients and age and sex matched 90 normal coronaries as control group. With total aseptic precaution 3 ml blood was collected. Enzyme linked immunosorbant assay was performed for all subjects to detect the presence of IgG and IgA antibodies to Chlamydia pneumoniae (Cp). Results: IgG and IgA Cp antibodies were detected in 67.8% and 58.9% CAD patients compared to 45.6% and 11.1% controls. IgG + IgA Cp antibodies were detected in 88.9% CAD patients when compared to 50.0% controls. Seroprevalence of IgG and IgA Cp antibodies were high among CAD patients compared to controls and was found statistically significant. A significant presence of Chlamydia pneumoniae antibodies was detected in smokers, diabetes mellitus, hypertension, and dyslipidemia. Conclusion: In the present study, the seroprevalence of IgG and IgA Cp antibodies was found to be higher in CAD patients compared to controls. The present study supports the association between Chlamydia pneumoniae infection and Coronary artery disease.

Enterococci: A journey of a successful pathogen.

Introduction: A dynamic homeostasis is maintained between the host and native bacteria of the gastrointestinal tract in humans, but migration of bacteria from the gut to other organs can lead to disease or death. Enterococci, traditionally viewed as commensal bacteria are now acknowledged to be organisms capable of causing life-threatening infections in humans, especially in the nosocomial environment. The existence of Enterococci in such a dual role is facilitated by its intrinsic and acquired resistance to virtually all antibiotics currently in use. Objective: The present pilot study was taken up to compare the multidrug resistance prevalence in commensal Enterococci and pathogenic Enterococci. Material and methods: A total of 50 commensal Enterococci isolated from stool samples and 50 clinical samples yielding Enterococci were taken for the study. Antibiotic susceptibility testing was done using Kirby Bauer’s disk diffusion method. Minimum inhibitory concentration of Vancomycin was tested by using E- strip. Results: Among 50 commensal Enterococci, majority showed resistance to Ampicillin 50 (100%), Erythromycin 38 (76%), Clindamycin 30 (60%), higher level of resistance to high level Gentamycin 14 (28%), Linezolid 6 (12%), vancomycin 3 (6%). 23 (46%) isolates showed multi drug resistance (resistance to ≥ 3 categories of antibiotics). Among 50 clinical isolates, majority showed resistance to Ampicillin 50 (100%), Erythromycin 38 (76%), Clindamycin 30 (60%), higher level of resistance to high level Gentamycin 14 (28%), Linezolid 6 (12%), vancomycin 3 (6%). 23 (46%) isolates showed multi drug resistance (resistance to ≥ 3 categories of antibiotics). Among 50 clinical isolates, majority showed resistance to Ampicillin 50 (100%), Clindamycin 46 (92%), Tetracycline 46 (92%), Erythromycin 41 (82%), Linezolid resistance was seen in 8 (16%) and Vancomycin resistance in 5(10%) clinical isolate. 48(96%) showed multi drug resistance. Conclusion: Boundary line between pathogenic and commensal Enterococci is blurred due to exchange of resistant traits. Regular screening of enterococcal isolates for resistance detection should be implemented. It is very important to consider infection control measures, screening of health care workers, surveillance cultures which can control spread of multidrug resistant Enterococci.

CD4 count evaluation in HIV-TB co infection before and after anti-tubercular treatment.

Background: The global impact of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection is one of the major public health challenge. India has a very high burden of TB according to the WHO. A decrease in CD4 counts in HIV-TB co-infection leads to an increase in morbidity and mortality. Methods: Information regarding the duration of HIV, type of TB, CD4 counts before and after ATT and any associated Opportunistic Infections (OIs) were collected from the records of 100 patients with HIV-TB co-infection who attended ART centre for a period of one year. The collected data was statistically analyzed. Results: In the study group, 35 had Pulmonary Tuberculosis (PTB) and 65 had Extra Pulmonary Tuberculosis (EPTB), 40 had OIs. Mean CD4 count prior to ATT in PTB was 197 (7-940), EPTB 192 (13-683) and with OIs 129 (7-288). After completion in PTB was 300, EPTB 302 and 252 in OIs. Least CD4 count of 121 was observed in patients above 50yrs and after completion it was 133. Incidence of both EPTB and PTB was higher in males 66.2% and 62.9%, and in the age group of 31-50 yrs 50.8% and 60% (Cell counts expressed in cells/μl.). Conclusion: In our study, we found that there was significant recovery of CD4 cells following ATT. Difference in CD4 counts among patients with PTB and EPTB was not significant. There was remarkable reduction of CD4 counts in patients who had other OIs and the recovery after ATT was also marginal.

Absolute lymphocyte count as a surrogate marker for CD4 counts after six months of HAART initiation in a resource-limited setting in India.

Background & objectives: Owing to the ever-expanding access to HAART (highly active anti-retroviral therapy) in resource-limited settings, there is a need to evaluate alternate markers like absolute lymphocyte count (ALC) as a surrogate for CD4 counts. This study was done to assess the usefulness of ALC as a surrogate marker for CD4 counts in monitoring HIV-infected patients after HAART initiation. Methods: In this study, 108 HIV-positive adult patients of both sexes fulfilling the inclusion criteria were included. CD4 and ALC were recorded at baseline. After initiation on HAART, these patients were followed up at three month intervals. Results: ALC and CD4 counts were positively correlated (Spearman correlation coefficient= 0.553). After six months of HAART, the sensitivity of an ALC increase as a marker for CD4 count increase at six months was 82 per cent, specificity was 100 per cent, PPV was 100 per cent and NPV was 31 per cent. Area under the corresponding ROC curve for CD4 increase of >100 cells/μl was 0. 825 ± 0.053. Interpretation & conclusions: ALC may be a useful surrogate marker in predicting an increase in CD4 counts as a response to HAART, but of questionable value in predicting a decrease in CD4 counts.

Opportunistic infections in relation to antiretroviral status among AIDS patients from south India.

Background: There is a need to generate data from India on relative frequencies of specific opportunistic infections (OIs) in different regions and their relation to the choice of commonly used generic highly active anti-retroviral therapy (HAART) regimens. Objectives: To document the prevailing prevalence pattern of OIs both before and after HAART, to look for reduction in OIs following HAART, to assess the risk of developing new OIs within 6 months of HAART initiation and to see if there is any difference in the risk of developing a new OI within 6 months of HAART initiation, for those on Efavirenz (EFV)-based regimens and Nevirapine (NVP)-based regimens. Materials and Methods: In a prospective observational cohort study conducted in South India involving 108 ART-naive AIDS patients, different pathogens were isolated and identified using standard laboratory techniques. Data analysis was done using SPSS software (version 16.0). Risk of developing an OI after HAART initiation was assessed using the likelihood ratio test from Cox regression models. Results: Tuberculosis (53.4%), oral Candidiasis (27.2%) and Herpes Zoster (14.7%) were the common infections seen. There was a drastic reduction of 96.59% in OI events after 6 months of HAART. The risk of developing an OI within 6 months of HAART initiation was 5.56%. Time to development of an OI in the first 6 months of HAART was shorter for the NVP-based regimens than with EFV-based regimens, but this difference was not statistically significant (HR=0.891, 95% CI: 0.179-4.429; P=0.888). Conclusion: Tuberculosis is the most important OI before initiation of HAART. Both EFV and NVP-based regimens are equally efficacious in controlling OIs.