Diabetes mellitus and HIV as co-morbidities in tuberculosis patients of rural south India

OBJECTIVES: Incidence of tuberculosis [TB] is greatest among patients with impaired immunity. India is experiencing a double epidemic of HIV and diabetes mellitus [DM], both of which are strongly associated with immuno-suppression. This study aimed to discover the prevalence of HIV and DM in both the pulmonary and extra-pulmonary TB patients of rural south India, retrospectively. Methods: Medical records of 192 microbiologically diagnosed pulmonary TB and 37 extra-pulmonary TB patients were thoroughly studied and data were extracted. The frequency distribution of HIV and DM was evaluated along with other demographic details such as age, sex and occupation in both groups. Results: The mean age of the pulmonary TB patients was 41.11+/-15.7 years, with significantly higher [p<0.0001] preponderance of DM [31.8%] over HIV [8.9%]. 72.13% of the diabetic patients belonged to the age group of 41-60 years. Extra-pulmonary TB patients had a mean age of 34.62+/-12.9, years with a significantly higher [p<0.006] HIV prevalence of 32.43% over DM [5.4%]. 75% of the HIV patients belonged to the age group of 41-60 years. Occupationally, the majority of the pulmonary TB patients were agricultural labourers [25.2%] while the majority of the extra-pulmonary TB patients were housewives or self employed [18.92%]. Conclusion: Though more importance is being given to HIV-TB coinfection, we cannot overlook DM, which showed a significantly higher prevalence in pulmonary TB patients compared to HIV. The rising prevalence of DM in high TB burden countries may adversely affect TB control.

Hepato-pulmonary amebiasis: a case report

Infections with Entamoeba histolytica are seen worldwide and are more prevalent in the tropics. About 90 percent of infections are asymptomatic, and the remaining 10 percent produce a spectrum of clinical syndromes, ranging from dysentery to abscesses of the liver or other organs. Extra-intestinal infection by E. histolytica most often involves liver. Pleuro-pulmonary involvement, seen as the second most common extra-intestinal pattern of infection, is frequently associated with amebic liver abscess. Pulmonary amebiasis occurs in about 2-3 percent of patients with invasive amebiasis. We report herein the case of a 45-year-old male presenting with hepato-pulmonary amebiasis. The diagnosis was established from direct examination of sputum, in which trophozoites of E. histolytica were detected, and by serology. Following treatment with metronidazole and chloroquine, the clinical evolution improved significantly. On regular follow-up visits, the patient was asymptomatic. This case report reiterates the need for collaboration between clinicians and microbiologists for timely diagnosis of such infections.

In vitro scanning electron microscopic study on the effect of doxycycline and vancomycin on enterococcal induced biofilm

Enterococcus [E] faecalis bacteria adhere to dentine of teeth root canals to form the biofilm. E. faecalis has been shown to be resistant to antibiotics. This in vitro study aimed to investigate the efficacy of vancomycin and doxycycline in inhibiting E. faecalis biofilm formation. A total of 60 extracted human teeth were incubated with E. faecalis [ATCC 35550 strain] for 45 days to allow biofilm formation. The teeth were equally divided into six groups [n=10]: 1] positive control, 2] negative control, 3] doxycycline alone 4] doxycycline with filing, 5] vancomycin alone, 6] vancomycin with filing. The relevant canals were irrigated with 4|tig/mL of either vancomycin or doxycycline antibiotic. Teeth were processed for scanning electron microscopy [SEM]. Areas of biofilm remaining in the canals after antibiotic treatment were measured with Scion image analysis software using the SEM images. Vancomycin is more effective in reducing the overall biofilm area compared with doxycycline; moreover filing after antibiotic administration increased this effect. We can conclude that vancomycin had greater efficacy than doxycycline for inhibiting and reducing E. faecalis biofilms growth in root canals. However, it failed to completely eliminate biofilm formation