DETECTION OF CARBAPENEMASE PRODUCING ENTEROBACTERALES AMONG THE CLINICAL ISOLATES OF DIARRHOEAGENIC ESCHERICHIA COLI CAUSING ACUTE GASTROENTERITIS IN CHILDREN BELOW 2 YEARS IN TERTIARY CARE HOSPITAL OF NORTH EAST INDIA.

Introduction: Enterobacterales that test resistant to at least one of the carbapenem antibiotics (ertapenem, meropenem, doripenem, or imipenem) are called Carbapenem resistant Enterobacterales (CRE) and if they produce a carbapenemase (an enzyme that can make them resistant to carbapenem antibiotics) they are called Carpenemase producing Enterobacterales (CPE). Children with CRE strains in fecal samples are considered as a high risk group by World Health Organization (WHO), which can spread CRE by intimate contact and travel. This cross-sectional study was conducted in the Departm Methods: ent of Microbiology, RIMS, Imphal, Manipur, India from Jan 2020 to Feb 2022. A total of 157 children under 2 years of age whose stool culture was positive for diarrhoeagenic Escherichia coli were included in the study. The modified carbapenem inactivation method (mCIM) has been done for detection of carbapenemase producers and the addition of EDTA in eCIM to further differentiate between serine and metallo-?-lactamase producers. Out of 157 Result and Discussion: Diarrhoegenic E.coli (DEC) ,Carbapenem resistance was seen in 9 isolates i.e 5.7 %. Out of these 9 isolates, 3 were MBL producers tested by the phenotypic test mCIM and eCIM. All the three MBL producers carried bla NDM-1 gene. mCIM/eCIM assay is designed to simultaneously detect and distinguish the different types of carbapenemases. Carbapenemase genes are often located on plasmids that can be exchanged between Enterobacteriaceae and other Gram-negative bacteria. Carbapenem-resistant K. pneumoniae are currently more frequent and more likely to cause healthcareassociated outbreaks, carbapenem-resistant E. coli pose a greater risk for spread in the community. Conclusion: Screening for carbapenemase producer using mCIM and eCIM essay is important along with infection control measure such as active surveillance through rectal screening for CRE carriage on hospital admission, contact precautions, hand hygiene, patient isolation, environmental sanitation, case notification/fiagging, antibiotic restriction.

Biofilm production and its correlation with antibiotic resistance pattern among clinical isolates of Pseudomonas aeruginosa in a tertiary care hospital in north-east India

Background: Pseudomonas aeruginosa is an ubiquitous pathogen capable of surviving in a variety of environmental conditions. It is increasingly gaining importance as a multidrug resistant nosocomial pathogen. Biofilm acts as a barrier, reducing the penetration of these drugs and consequently, preventing them from exercising their actions. The aim of this study is to isolate and identify Pseudomonas aeruginosa from various clinical specimen and to find out their production of biofilms and their correlation with antibiotic susceptibility pattern.Methods: All Pseudomonas aeruginosa over a period of 1 year were isolated and identified from clinical specimens and antibiotic susceptibility test was done following standard operative procedures. Biofilm detection was done by Congo Red Agar method (CRA).Results: 134 isolates of Pseudomonas aeruginosa was isolated. Maximum isolates were isolated from sputum samples 55 (41%) and most were from wards 68 (51%) giving a probability of increased healthcare associated infections. Biofilm production by the isolates was seen in 39 (29%). All the biofilm producing isolates shows more resistant pattern in comparison to non-biofilm producers. 69% of Imipenem and 82% of Meropenem resistant isolates produce biofilm. All the P. aeruginosa including MDR and biofilm forming strains were sensitive to Colistin.Conclusions: Resistance to antimicrobial agents is the most important feature of biofilm infections. Ability of P. aeruginosa to form biofilms renders antibiotic treatments inefficient and therefore promotes chronic infectious diseases. As a result, infections caused by bacterial biofilms are persistent and very difficult to eradicate.

Methicillin resistant Staphylococcus aureus (MRSA) in India Prevalence & susceptibility pattern.

Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA) is endemic in India and is a dangerous pathogen for hospital acquired infections. This study was conducted in 15 Indian tertiary care centres during a two year period from January 2008 to December 2009 to determine the prevalence of MRSA and susceptibility pattern of S. aureus isolates in India. Methods: All S. aureus isolates obtained during the study period in the participating centres were included in the study. Each centre compiled their data in a predefined template which included data of the antimicrobial susceptibility pattern, location of the patient and specimen type. The data in the submitted templates were collated and analysed. Results: A total of 26310 isolates were included in the study. The overall prevalence of methicillin resistance during the study period was 41 per cent. Isolation rates for MRSA from outpatients, ward inpatients and ICU were 28, 42 and 43 per cent, respectively in 2008 and 27, 49 and 47 per cent, respectively in 2009. The majority of S. aureus isolates was obtained from patients with skin and soft tissue infections followed by those suffering from blood stream infections and respiratory infections. Susceptibility to ciprofloxacin was low in both MSSA (53%) and MRSA (21%). MSSA isolates showed a higher susceptibility to gentamicin, co-trimoxazole, erythromycin and clindamycin as compared to MRSA isolates. No isolate was found resistant to vancomycin or linezolid. Interpretation & conclusions: The study showed a high level of MRSA in our country. There is a need to study epidemiology of such infections. Robust antimicrobial stewardship and strengthened infection control measures are required to prevent spread and reduce emergence of resistance.

Co-infection of herpes simplex virus (HSV) with human immunodeficiency virus (HIV) in women with reproductive tract infections (RTI).

In India, HSV seroprevalence and its coinfection with HIV among female patients with reproductive tract infections (RTI) are sparse. We aim to ascertain the seroprevalence of HSV and its coinfection with HIV and common sexually transmitted infections attending Obstetrics and Gynaecology outpatient department, RIMS. The study included 92 female patients with RTI. Diagnostic serology was done for HSV-1 and HSV-2 using group specific IgM indirect immunoassay using ELISA, HIV by 3 ELISA/Rapid/Simple (E/R/S) test of different biological antigen. Diagnosis of RTI was made on clinical grounds with appropriate laboratory investigations--microscopy, Gram stain smear etc. Bacterial vaginosis was diagnosed using Nugent's criteria, Syphilis by rapid plasma reagin (RPR) card test and Chlamydia trachomatis by IgG ELISA. Out of 92 sera tested for HSV, 18 (19.6%) were IgM HSV positive and 9 (9.8%) were HIV positive. Co-infection rate of HSV in HIV positive was 16.7%. None of the patients had clinical herpes genitalis, all were subclinical cases. 55.5% of HSV positives belongs to age group 21 to 30 years. Of the HSV-1 and HSV-2 IgM positives 3 (15%) had HIV, 4 (22.2%) bacterial vaginosis, 2 (11.1%) were RPR positive, 4 (22.2%) Chlamydia trachomatis, 3 (15%) were pregnant. 16 (88.8%) were unemployed, 14 (77.7%) had education level below 10 standard. Our study suggest that every case of RTI, be it an ulcerative or nonulcerative must be thoroughly evaluated by laboratory testing for primary subclinical genital HSV coinfection as this has profound implications on their judicious management and aversion of complications. Early diagnosis and treatment of HSV infection together with prophylaxis for recurrent HSV disease will prevent progression and spread of HIV disease.

Penicillium marneffei--an indicator disease of AIDS: a case report.

Penicillium marneffei (PM), the only dimorphic species of the genus penicillium is the etiological agent of penicilliosis marneffei. This opportunistic fungal infection occurs among human immunodeficiency virus (HIV) infected and other immunocompromised patient in several regions of South-east Asia, where the infection is considered as an indicator disease of AIDS. A case of penicilliosis marneffei is reported in a patient whose HIV status was unknown and later turned to be in the late stage of AIDS. This demonstrates that it is indeed an indicator disease of AIDS. In India, penicilliosis has been reported among the inhabitants of Manipur state where the prevalence of HIV infection / AIDS is very high. The causative agent was first isolated from a captive bamboo rat. Investigation of the prevalence of the organism among bamboo rats of different countries of South East Asia revealed four species of bamboo rats to be harboring the organism. These four species of bamboo rats are Rhizomys sinensis, R. pruinosus, R. sumatrensis and Cannomys badius. In Manipur, Penicillium marneffei has been isolated from Cannomys badius. Any patient presenting with penicilliosis marneffei should be subjected to HIV counselling and testing if the HIV status is not known and further study regarding the ecology and epidemiology of the fungus is needed.

Pattern of hepatitis C virus genotypes in HIV infected patients in RIMS, Hospital, Imphal, Manipur.

The present study was carried out to find the pattern of genotype distribution of Hepatitis C virus. Twenty-three Hepatitis C virus positive serum samples in various age-groups of both sexes attending, Microbiology Department, RIMS during the period from September 2002 to December 2004 were studied for Hepatitis C genotype. These HCV positive serum samples were sent to National Institute of Cholera and Enteric Diseases, Kolkata. The serum samples were tested for HCV-RNA by qualitative RT-PCR test and then genotyped by type specific RT-PCR. Out of 23 serum samples, 22 were males. All the 23 HCV positive serum samples were also tested positive for HCV-RNA by qualitative RT-PCR. Majority of the cases belonged to the age group of 31-40 years. Higher percentage of Hepatitis C cases were Injecting Drug Users and next to it were patients with multiple sexual contacts. Among the IDUs, Hepatitis C virus 3a type was the commonest genotype (61.1%) followed by 1b (22.2%) and 3b (16.7%) respectively. Hepatitis C genotype 3a was predominant (52.2%) followed by 1b (26%) and 3b (21.8%). HCV genotype 3a occurred most commonly in the age group of 21-40 years.

Co-infection by human immuno deficiency virus, hepatitis B and hepatitis C virus in injecting drug users.

Injecting drug users (IDUs) are at risk of parenterally transmitted diseases such as hepatitis B virus (HBV) hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections. The present study was undertaken to find out the prevalence of HIV infection, HBV infection and HCV infection among IDUs of a deaddiction centre. Serum samples from 250, injecting drug users (IDUs) from a de-addiction centre were screened for HBsAg using immunochromatography, anti HCV antibody by 3rd generation ELISA test and anti HIV antibody by ELISA test and immunochromatographic rapid test during the period August to October 2002. One hundred and forty-nine (59.6%) IDUs were positive for HIV antibody, 226 (90.4%) were positive for anti HCV antibody and 27 (10.8%) were positive for HBsAg. There was co-infection of HIV, HBV and HCV in 15 (6%) of the IDUs. The Co-infection of HBV and HCV were found in 12 cases (4.8%) and Co-infection of HIV and HCV was found in 131 cases (52.4%). The IDUs were in sexually active age group with a risk of infection to their sexual partner. There is high prevalence of HCV and HIV infection and co-infection of both viruses among IDUs. Comprehensive public health interventions targeting this population and their sexual partners must be encouraged. Increase coverage of needle, syringe exchange programme (NSEP) to young and new IDUs is required before they are exposed to blood borne viruses.

Pulmonary paragonimiasis.

A 27-year-old married male from Lamdeng village of Imphal West District, Manipur presented with cough, fever, haemoptysis, anorexia and weight loss, and was treated with antituberculosis drugs continuously for one year without improvement. He also had history of ingestion of raw crabs. Chest radiograph revealed right midzone lesion with cavitation. Laboratory investigations revealed peripheral blood eosinophilia, elevated erythrocyte sedimentation rate and sputum smear revealed eggs of Paragonimus westermani. He responeded well to treatment with praziquantel 25 mg/kg, three times a day for three days and is doing well on follow-up. Pulmonary paragonimiasis must be considered in the differential diagnosis of slowly resolving pneumonias, especially in the appropriate clinical setting because effective treatment with praziquantel can be rewarding.