ABSTRACT
Background: Non albicans species are emerging increasingly as significant ICU pathogens. The increasing incidence of C. tropicalis infections is a significant problem because of its ability to develop rapid resistance to fluconazole.Methods: The study was designed to isolate, evaluate the risk factors and outcome of C. tropicalis infection from intensive care units. Identification was done by the biochemical methods. A total of 89 patients culture positive for C. tropicalis were selected for retrospective analysis over a period of one year. We collected various data about risk factors and outcome from the medical records.Results: A total of 89 patients culture positive for Candida tropicalis were analysed. Majority of these culture isolates were obtained from their blood (59.55%) followed by urine samples (31.46%). The indwelling devices (93.2%) remained a highest risk followed by prolonged administration of antibiotic therapy (92.1%) and admission in ICU for more than a week (88.8%). Overall mortality rate was 31.5%. Mortality was higher in patients with longer total length of stay in hospital (89.3%; p 1.000), indwelling devices (85.7%; p 0.5663) and in whom the antimicrobial therapy was administered for prolonged duration (82.1%; p 0.7581), although these factors remained statistically insignificant. 92.1% of isolates were sensitive to amphotericin B and showed 52.8%; 9.0% sensitivity to itraconazole and fluconazole respectively.Conclusions: C. tropicalis is now classified as the third or fourth NAC species being commonly isolated from clinical samples and associated with persistent systemic infections leading to a longer stay in the hospital. Several virulence factors seem to be responsible for high dissemination and mortality.
ABSTRACT
Background: Pulmonary Tuberculosis is caused by mycobacterium tuberculosis. C-reactive proteins (CRP) are produced in the body by liver in response to inflammation caused by Mycobacterial infection. Insufficient information is available in medical literature, correlating serum CRP levels to the severity of pulmonary tuberculosis. The present study was undertaken to correlate the validity of serum CRP levels to clinical findings. Severity of pulmonary tuberculosis, need for ventilator support, response to anti-tubercular therapy and mortality. Objectives: To correlate the serum CRP levels with clinical findings, mortality, radiological severity and response to anti-tubercular treatment in patients suffering from pulmonary tuberculosis. Methods: The present study was conducted in 50 new sputum positive pulmonary TB patients and 50 healthy individuals. The patients were evaluated for clinical and radiological findings, which were correlated to baseline CRP levels. CRP levels were measured at 2 months and after completion of treatment and correlated to treatment end results. Results: Mean baseline CRP levels in pulmonary tuberculosis patients were 55.32mg/L (range 16- 144mg/L).CRP levels among normal healthy individuals were 4.46 mg/L (range 2-8mg/L). CRP levels were significantly higher in TB patients with fever, tachycardia, tachypnea, hypotension, respiratory distress and the need for ventilatory support when compared to patients without these features. The study showed significant correlation between CRP levels and radiological extent of disease. Baseline CRP levels were significantly higher in mortality group when compared to survivor group.CRP levels showed progressive decline in patients who were cured. Conclusion: The CRP levels in pulmonary tuberculosis patients before initiating anti-tubercular therapy showed a positive correlation with features like presence of fever, tachycardia, tachypnea, hypotension, respiratory distress, need for ventilator support, radiological severity and in patients who died. Thus, serum CRP levels can be used as a surrogate marker for severity of pulmonary tuberculosis in the patients. This is probably the first study conducted in North India correlating CRP levels and disease severity of pulmonary Tuberculosis to the best of our knowledge.
ABSTRACT
Background: Acinetobacter has gained importance as an emerging multi drug resistant nosocomial pathogen among non fermenting aerobic gram negative bacteria, especially in intensive care units. This organism is contributing to increased morbidity and mortality with strong propensity to colonize and disseminate among humans and environmental sources. Materials and Methods: A retrospective observational study was conducted from February 2013 to December 2013. Various clinical specimens received in microbiology laboratory from inpatients and outpatients were studied including their antimicrobial resistance pattern. A total of 111 Acinetobacter species isolates were included in the study. Associated risk factors were recorded from the clinical data which included demographic characteristics of the patient along with the indoor department, period of stay in ICU and hospital, presence of indwelling devices, antimicrobial therapy, surgical interventions, focal or generalized infections and underlying chronic morbid diseases. Results: In current study maximum number of Acinetobacter was from urine specimen (57.66%) followed by blood (25.23%). Among inpatients highest percentage of isolates was recovered from general surgical ward (26.88%) followed by intensive care units (24.73%). The number of MDR & XDR isolates recovered was 21(18.92%) & 11(10%) respectively. Imipenem, Meropenem and Doxycycline remained efficacious drugs against Acinetobacter infections with resistance rates of 18.02%, 30.63% and 36.94% respectively. The study revealed focal/generalized infections, indwelling devices, duration of stay in ICU & hospital, mechanical ventilation as significant risk factors in decreasing order for acquisition of MDR and XDR Acinetobacter but according to the statistical analysis only Diabetes mellitus was found to be significant (p value 0.019) whereas all other factors remained insignificant ( p value > 0.05). Conclusion: Prolonged usage of indwelling devices & medical equipments in critically ill patients along with longer duration of hospitalization can facilitate colonization and infection with Acinetobacter which is otherwise a low virulence pathogen. Strict compliance of disinfection policy and infection control programme with rational use of antibiotics especially carbapenems in Acinetobacter infections shall help in curtailing drug resistant strains from further dissemination.
ABSTRACT
Postmortem artifacts are commonly encountered problems in routine. They had to wrong interpretation in number of cases especially at the hands of an inexperienced autopsy surgeon and hence may mislead the course of justice. So it is suggested that all the doctors concerned with medicolegal work, especially autopsies, should be well versed with these artifacts. Then only our opinion will be conclusive and aid in the administration of justice.