Clinico-epidemiological analysis of scrub typhus in hospitalised patients presenting with acute undifferentiated febrile illness: A hospital-based study from Eastern India

Acute undifferentiated febrile illness (AUFI) constitutes the predominant cause of healthcare seeking in Odisha. This prospective study was conducted to analyse the clinical, epidemiological and laboratory profile of scrub typhus patients presenting with AUFI from January to December 2017. Four hundred and thirty-two samples were tested for dengue, malaria, scrub typhus and enteric fever. Scrub typhus was overall the most common cause of AUFI (26.3%, 114/432) followed by dengue (19.2%, 83/432). Eschar was seen in 6.1% of cases. Aetiologies of 38.6% of AUFI remained unidentified. In the present study, there was no mortality attributed to scrub typhus.

Deciphering polymyxin B minimum inhibitory concentration from colistin minimum inhibitory concentration and vice versa: An analysis on 156 carbapenem-resistant Enterobacteriaceae isolates

The susceptibility determination to polymyxins (colistin and polymyxin B) remains a challenge for clinical microbiology laboratories. We evaluated the minimum inhibitory concentration (MIC) of both antimicrobials by the broth microdilution method in a selected subset of 156 carbapenem-resistant Enterobacteriaceae (CRE) isolates. Good concordance between polymyxin B and colistin MIC values was obtained, and there was 98% categorical agreement in CRE isolates. Future large-scale multicentre study is needed to draw conclusion if the MIC of colistin can be used to extrapolate the MIC of polymyxin B and vice versa.

Extradigital glomus tumor as a cause of chronic perianal pain.

Glomus tumor is a rare perivascular benign tumor arising from the Sucquet-Hoyer canal of the normal glomus body, most commonly in the digital areas. We report a serving soldier with such a tumor in an atypical site, the perianal region, presenting with episodic shooting pain. Total surgical excision was performed. Histopathology revealed a well-circumscribed tumor composed of clusters of monotonous polygonal cells surrounding capillary-sized blood vessels. Tumor cells also showed immunopositivity for smooth muscle antigen and vimentin. Following excision, the patient was completely relieved of pain and there was no recurrence on follow-up for 6 months.

Early detection of HIV-1 in infants by PCR.

Infants of HIV-infected mothers are at great risk of becoming infected with HIV during childbirth. Many infants acquire HIV during labor and delivery. Others can acquire HIV through the mixing of fetal and maternal blood as the placenta separates. The duration of membrane rupture, acute chorioamnionitis and invasive delivery techniques that increase the baby's contact with the mother's blood have been associated with higher risks of MTCT during labor and delivery. HIV is present in breast milk and risk of its transmission during breastfeeding depends on several factors, including: infant age, pattern of breastfeeding, breastfeeding duration, breast health, maternal viral load and maternal immune status. Infants born to HIV infected mothers carry their mother's antibodies in their blood into the second year of life, even if the infants themselves are not infected. For this reason, standard HIV antibody tests cannot reliably confirm HIV infection in infants until after the maternal antibodies have disappeared. Tests that can diagnose pediatric HIV infection accurately during the first year of life include HIV-PCR, CD4/CD8 counts, P24 antigen tests, and viral cultures. PCR offers an effective tool to reliably diagnose HIV in a pediatric age group. Nineteen infants born by normal delivery to HIV-1 seropositive mothers were studied by PCR for the HIV1 env gene. Thirteen babies (68.5%) were negative whereas 6 babies were found to be positive (31.5%). Although PCR is one of the most useful tests for this clinical situation, it is not definitive. Therefore, PCR should be interpreted with caution and repeated at regular defined intervals, preferably lasting until the HIV antibody status of the infant is resolved.

In vitro explant culture of mantle epithelium of freshwater pearl mussel.

The in vitro culture of nacre secreting pallial mantle explants of freshwater pearl producing mussel, Lamellidens marginalis (Lamarck) included depuration of pearl mussels with different physical and chemical agents to eradicate various commensals, removal of pallial mantle ribbon, aseptic preparation of explants from the ribbon and transfer of those explants into tissue culture petri dishes. Special synthetic tissue culture media enriched with additives viz., inactivated calf fetal serum and antibiotics were poured into plates with explants. The culture plates were incubated at 30 degrees C in a CO2 incubator at 5%, CO2. The cultures could be maintained for 42-45 days without any contamination. After 12 hr epithelial like cells began to migrate out and formed a complete cell sheet surrounding the explant within 12-15 days. The epithelial cells in the culture indicated functional viability as subsequently after 38-40 days of culture, typical aragonitic 'nacre' crystals of CaCO3 could be observed throughout the culture plates.

Evaluation of trisodium phosphate as a transport medium and its utility in a single-step decontamination technique for the culture of M. tuberculosis.

Background Sputum specimens were received from various out-patient departments of a tertiary care referral hospital to acid-fast staining and mycobacterial culture. Material & Methods A simple, one-step decontamination and concentration method was adopted before subjecting the samples to acid-fast staining and mycobacterial culture. Trisodium phosphate, a cheap, “soft” decontaminant-cum-liquefying agent was used to treat the sputum specimens before Ziehl-Neelsen’s (ZN) acid-fast staining and Lowenstein-Jensen’s (LJ) medium culture. The sputum samples were collected directly into trisodium phosphate containing screw capped McCartney bottles (Day-0). The bottles were vortexed and left overnight at room temperature. On the subsequent morning (Day-1), the supernatants were discarded and smears made from deposits were stained by ZN stain. Results A total of 30 consecutive samples, which showed smear positivity by ZN technique, were selected for the present study. Deposits from these smear positive cases were cultured onto duplicate slants of LJ medium and incubated at 370C (Day-1). Duplicate slants of LJ media were inoculated from each of these preserved deposits on 2nd, 3rd , 4th, 6th and 8th days. Culture bottles were incubated at 370C for 8 weeks and positive growths were recorded. Culture retrieval was possible from 29 (96.7%) samples from deposits of Day –1 to Day-3. The culture positivity , however, had dropped to 26 (86.7%),18 (60%) and 6 (20%) from deposits of Day-4, Day-6 and Day-8, respectively. All the isolates were identified as M. tuberculosis and there was minimal contamination (0.83%). The culture retrieval dropped significantly only after Day-3. Conclusion This method is, therefore, suitable for transportation, preservation and decontamination of sputum samples before staining and culture, up to 3 days after collection. This will be helpful especially for collection of sputum samples from distant places and their transportation to nearest mycobacteriology laboratory as also for sputum samples arriving late in a working day’s schedule.