Suspecting and diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM) in India: An Indian expert consensus

Transthyretin cardiac amyloidosis (ATTR-CM) is a rare and under-recognized disorder characterized by the aggregation of transthyretin-derived insoluble amyloid fibrils in the myocardium. Heterogeneity of symptoms at presentation, makes its diagnosis often delayed. An expert panel gathered on a virtual platform across India to conduct a meeting for developing a guiding tool for ATTR-CM diagnosis. The panel recommended younger age (40 years) for suspecting ATTR-CM and thick-walled non-dilated hypokinetic ventricle was considered as one of the important red flags. Electrocardiogram (ECG) and echocardiography (ECHO) findings were recommended as primary tests to raise the suspicion while nuclear scintigraphy and hematological tests were recommended to confirm the diagnosis and rule out amyloid light-chain (AL) amyloidosis. Cardiac magnetic resonance (CMR) and biopsy were recommended in case of ambiguity in the presence of red flags. Considering the lack of expert guidelines in the Indian scenario, a standardized diagnostic algorithm was also proposed.

Dengue in pregnancy: an under-reported illness, with special reference to other existing co-infections

OBJECTIVE@#To keep the level of awareness high as far as incidence of dengue among pregnant women is concerned.@*METHODS@#A total of 300 blood samples of patients with fever in pregnancy were received in the Department of Microbiology to rule out dengue infection (January 2011 to December 2012). The samples were put up for presence of dengue IgM antibodies and NS1Ag by ELISA. The patients who turned out to be positive for dengue serology were retrospectively analysed with respect to patient's age, gestational age, clinical presentation, complications, platelet counts and maternal as well as foetal outcomes.@*RESULTS@#Out of 300 females tested, 22 (7.3%) were found positive for dengue infection during the said time period. Out of them 9 were positive for IgM antibodies against dengue and 10 were found to be positive for NS1Ag, while 3 were positive for both IgM antibody and NS1Ag. Five patients presented with dengue in first trimester, 9 in second trimester and 8 in third trimester. Two patients had coinfections. Patient with coinfection of dengue with malaria had intrauterine death of fetus at 37 weeks while the second one having dengue with typhoid had a preterm vaginal delivery at 35 weeks.@*CONCLUSIONS@#Establishing diagnosis of dengue infection in pregnancy is important for effective management by the obstetricians particularly the mode of delivery due to the potential risk of hemorrhage for both the mother and the newborn. Co-infections seen in endemic areas may be more common than usually reported.

Dengue in pregnancy: An under-reported illness, with special reference to other existing co-infections

Objective: To keep the level of awareness high as far as incidence of dengue among pregnant women is concerned. Methods: A total of 300 blood samples of patients with fever in pregnancy were received in the Department of Microbiology to rule out dengue infection (January 2011 to December 2012). The samples were put up for presence of dengue IgM antibodies and NS1Ag by ELISA. The patients who turned out to be positive for dengue serology were retrospectively analysed with respect to patient's age, gestational age, clinical presentation, complications, platelet counts and maternal as well as foetal outcomes. Results: Out of 300 females tested, 22 (7.3%) were found positive for dengue infection during the said time period. Out of them 9 were positive for IgM antibodies against dengue and 10 were found to be positive for NS1Ag, while 3 were positive for both IgM antibody and NS1Ag. Five patients presented with dengue in first trimester, 9 in second trimester and 8 in third trimester. Two patients had coinfections. Patient with coinfection of dengue with malaria had intrauterine death of fetus at 37 weeks while the second one having dengue with typhoid had a preterm vaginal delivery at 35 weeks. Conclusions: Establishing diagnosis of dengue infection in pregnancy is important for effective management by the obstetricians particularly the mode of delivery due to the potential risk of hemorrhage for both the mother and the newborn. Co-infections seen in endemic areas may be more common than usually reported.

Dengue in pregnancy：an under-reported illness, with special reference to other existing co-infections

Objective:To keep the level of awareness high as far as incidence of dengue among pregnant women is concerned.Methods:A total of 300 blood samples of patients with fever in pregnancy were received in the Department of Microbiology to rule out dengue infection (January 2011 to December 2012). The samples were put up for presence of dengue IgM antibodies and NS1Ag by ELISA. The patients who turned out to be positive for dengue serology were retrospectively analysed with respect to patient’s age, gestational age, clinical presentation, complications, platelet counts and maternal as well as foetal outcomes.Results:Out of 300 females tested, 22 (7.3%) were found positive for dengue infection during the said time period. Out of them 9 were positive for IgM antibodies against dengue and 10 were found to be positive for NS1Ag, while 3 were positive for both IgM antibody and NS1Ag. Five patients presented with dengue in first trimester, 9 in second trimester and 8 in third trimester. Two patients had coinfections. Patient with coinfection of dengue with malaria had intrauterine death of fetus at 37 weeks while the second one having dengue with typhoid had a preterm vaginal delivery at 35 weeks.Conclusions:Establishing diagnosis of dengue infection in pregnancy is important for effective management by the obstetricians particularly the mode of delivery due to the potential risk of hemorrhage for both the mother and the newborn. Co-infections seen in endemic areas may be more common than usually reported.

Outbreak of Salmonella Typhi enteric fever in sub-urban area of North India: a public health perspective

Outbreaks of enteric fever are a major health concern not only due to significant human morbidity and mortality but also fear of spread of multidrug resistant strains. We report an outbreak of enteric fever caused by Salmonella enterica serotype Typhi in a suburban area, in city Chandigarh of North India. Twenty-seven strains of S. typhi were isolated from blood cultures over a period of two weeks with 18 of these 27 patients residing in the same area. Maximum cases were in the age group 5-14 years (10 patients, 55.5%) while 4 (22.2%) cases were children under 5 years. All the strains showed similar resistogram being resistant to ampicillin and nalidixic acid, intermediate to ciprofloxacin and sensitive to chloramphenicol, ceftriaxone, cefotaxime, cotrimoxazole and azithromycin on disc diffusion testing. Minimum inhibitory concentration of ciprofloxacin was determined by agar dilution method and was found to be raised (≥ 2 μ g/mL). This nalidixic acid resistant S. typhi outbreak report warrants the necessity of implementing stringent sanitation practices in public health interest.

Trends in the Antibiotic Resistance Patterns of Enteric Fever Isolates – a Three Year Report from a Tertiary Care Centre

Objectives: The incidence of multidrug resistant enteric fever is increasing alarmingly. This study was planned to determine the rate of isolation of Salmonella spp. and to compare the isolates for their epidemiological parameters and antimicrobial susceptibility patterns at our center. Methods: The study was conducted over a span of three years with a total of 8142, 8134, and 8114 blood culture samples processed for the years 2008, 2009, and 2010 respectively. The minimum inhibitory concentration (MIC) for ciprofloxacin and chloramphenicol was determined using an agar dilution method. The MIC for ciprofloxacin was also confirmed by Epsilon-test (E -test) strips. Results: Of the total 302 Salmonella spp. isolated, 257 were Salmonella enterica serotype Typhi (85.1%) and 45 (14.9%) were S. enterica serotype Paratyphi A. The majority of the isolates recovered were from the pediatric age group (54.6%) and males (60.6%). Complete susceptibility was observed to chloramphenicol, cefotaxime, ceftriaxone, and azithromycin over the last two years (2009 and 2010), with an increase in resistance to nalidixic acid (100%) and ciprofloxacin (13.6%). Conclusions: In our study, we found augmentation of resistance to nalidixic acid and fluoroquinolones and complete sensitivity to ceftriaxone along with reemergence of chloramphenicol sensitivity for Salmonella isolates. This report emphasises the necessity of continuous surveillance of antibiograms of enteric fever isolates in an area.

Metallo- β - lactamase producing nonfermentative gram-negative bacteria: an increasing clinical threat among hospitalized patients

OBJECTIVE@#To detect and evaluate the various methods for metallo- β -lactamases (MBL) production in Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter species.@*METHODS@#A total of 109 P. aeruginosa and 85 Acinetobacter species were screened for imipenem resistance by Kirby-Bauer disc diffusion methods. Detection of MBL production was done by imipenem-EDTA combined disc test, double disc synergy test (DDST) and imipenem-EDTA MBL E test.@*RESULTS@#A total of 63 (57.8%) strains of P. aeruginosa and 46 (54.1%) strains of Acinetobacter spp. were found to be resistant to imipenem. Of the 63 imipenem resistant P. aeruginosa tested for MBL production, 44 (69.8%) were found to be positive and among 46 imipenem resistant Acinetobacter, 19 (41.3%) were shown to be the MBL producers.@*CONCLUSIONS@#Imipenem-EDTA combined disc test and MBL E test are equally effective for MBL detection in both P. aeruginosa and Acinetobacter spp., but given the cost-constraints, combined disc can be used as a convenient screening method in the clinical microbiology laboratory.

Linezolid resistant Staphylococcus haemolyticus: first case report from India

Linezolid is being increasingly used in the treatment of infections with gram-positive organisms especially methicillin resistant Staphylococcal isolates. Though resistance to this antimicrobial is emerging but it is extremely rare. Here we document first case of linezolid resistant Staphylococcus haemolyticus (S.haemolyticus) from India. This organism was isolated from pus oozing from a postsurgical site in 61 year old male hailing from an adjoining state of Haryana.

Salmonella-salmonellosis-rare presentations of a common pathogen

Salmonella are most commonly associated with gastroenteritis and enteric fever in humans. Occasionally, dissemination of bacilli throughout the body results in establishment of localized foci of persistent infection especially in patients with debilitating diseases and immunosuppressive states. Infection at various aberrant sites due to Salmonella has been reported relatively seldom. It has perfected the art of intracellular survival in niches from where they can cause myriad of effects. Six cases with Salmonella infection at unusual sites without any preexisting or underlying disease diagnosed over a period of two years are presented here. Salmonella etiology was not suspected in these patients and the diagnosis was made microbiologically only after culture isolation.

Surveillance of quality of drinking water

To study the status of bacteriological contamination of drinking water being supplied by the municipal corporation. Community based longitudinal study. Department of Community Medicine and Microbiology of Government Medical College. 133 Hand pumps and 107 taps from which people were using water for drinking purposes were included in the study. Bacteriological quality of drinking water was checked by Mackie and Mc Cartney's method; calculating most probable number [MPN] by presumptive coliform count. Water samples with MPN > 3 were considered unfit for drinking purposes. The bacteriological analysis of water samples was carried out for two years from July 2002 to June 2004. It showed that 47.4% hand pumps and 15.9% taps were supplying contaminated water; the range was from 40-70% and 27.8-57.9% during pre-monsoon to post-monsoon, seasons of respective years. The contamination of drinking water unfortunately appears to be a universal phenomenon in most of the developing countries. The authors conclude that there are two spheres, which needs to be strengthened. Firstly, the bacteriological quality of drinking water needs to be improved in general and special care is to be taken during pre-monsoon and monsoon periods. Secondly, regular campaigns may be carried out to inform the public about the importance of safe and potable water including methods for household disinfection of drinking water, during the pre-monsoon and monsoon periods when the incidence of contaminated water samples is highest in the region