ABSTRACT
Background & Objectives: Extended-Spectrum Beta-Lactamase (ESBL) producing members of the family Enterobacteriaceae are emerging worldwide The aim of this study was to evaluate risk factors, co-morbidity status and short term mortality rates among hospitalized patients with and without ESBL producing Enterobacteriaceae spp. urinary isolates. Methods: An analytical cross-sectional study conducted in a super-specialty hospital from December 2014 to July 2015. Urine samples from 100 patients which repeatedly yielded significant colony counts of Enterobacteriaceae spp. isolates were identified using standard biochemical tests. Antibiotic susceptibility testing of these isolates was carried out by modified Kirby Bauer disk diffusion method as per CLSI guidelines 2014. Isolates which were resistant to cefotaxime and/or ceftazidime were tested for the production of ESBL by phenotypic confirmatory disc diffusion test. Relevant clinico-epidemiological details of these patients were subsequently obtained from Medical records as per the proforma formulated. The original version of the Charlson Index (CI) was used to assess co-morbidity and short term mortality rates. Results & Interpretation: Escherichia coli followed by Klebsiella pneumonia were the predominant isolates. 40 isolates were confirmed as ESBL producers. All isolates had Multiple Antibiotic Resistance (MAR) index of >0.2. The p-value of difference in proportion of all the risk factors distributed among patients with and without ESBL producing urinary Enterobacteriaceae spp. isolates respectively was found to be >0.05. The p-value of difference in mean Charlson index scores between these two groups of patients was 0.45. Conclusions: The results obtained in our study are largely inconclusive. It is imperative that more number of multicentre studies should be conducted in order to generate conclusive evidence on this subject. [Mohit B NJIRM 2016; 7(5):40-45]
ABSTRACT
Allergic bronchopulmonary aspergillosis (ABPA) is a slowly progressive disease caused by hypersensitivity to Aspergillus fumigatus. This condition is most commonly seen in patients with asthma and cystic fibrosis. ABPA mimics a wide range of diseases, thereby further accentuating the difficulties faced by medical practitioners in diagnosing this condition. Even today, this condition remains under diagnosed in many countries with reports of mean diagnostic latency of ten years between the occurrence of symptoms and the diagnosis. We present a case report and review of literature with the aim of highlighting the complicated nature of this enigmatic illness.
ABSTRACT
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.