Molecular characterization of community- & hospital-acquired methicillin-resistant & methicillin-sensitive Staphylococcus aureus isolates in Sikkim.

Background & objectives: The two major genotypic markers that distinguish community acquired (CA) from hospital acquired (HA) methicillin resistant staphylococcus aureus (MRSA) isolates are the architecture of mobile genetic element (SCCmec type) and presence of panton valentine leukocidin (PVL) toxin. This study was conducted to determine the molecular characteristics of CA- and HA- MRSA and methicillin sensitive S. aureus (MSSA) isolates in Sikkim. Methods: A total of 150 clinical isolates of S. aureus isolated from various clinical specimens were subjected to duplex (mec-A and pvl gene) and multiplex (SCCmec typing) PCR. Results: of the 150 isolates, 53 (35.33%) and 66 (44%) were positive for mec-A (MRSA) and pvl genes, respectively. Thirty eight (25.33%) met the definition of CA-MRSA and 15 (10%) of HA-MRSA and the remaining 63 (42%) and 34 (22.66%) as CA- and HA-MSSA, respectively. No significant difference was seen in the distribution of PVL toxin in MRSA and MSSA isolates, but it was significantly (P<0.001) high in overall MRSA isolates than in MSSA. The majority of the MRSA isolates showed a double amplification band of SCCmec type III plus V (54.71%), and only a fewer isolates were amplified by single DNA fragments of type I (1.88%), III (3.77%), IVa (1.88%) and V (11.32%). SCCmec types I, III, IVa, were found only in HA-MRSA isolates, whereas type V in both the CA- and HA-MRSA. AST pattern showed that 18.42 per cent (7/38) and 46.66 per cent (7/15) were multidrug resistant (MDR)-CA-MRSA and MDR-HA-MRSA, respectively. Interpretation & conclusions: The present results show that SCCmec type V MRSA has been on the rise, and genotypic markers such as pvl gene detection used for the differentiation of these clinically distinct isolates of MRSA may not be reliable.

First case of Paragonimus westermani infection in a female patient in India.

Paragonimiasis is a foodborne parasitic zoonosis caused by lung fl uke species of the genus Paragonimus. The Paragonimus westermani is the most common human pathogen in Asian countries. In northeast India, Paragonimus heterotremus has been documented as the only human pathogen in the earlier literature. In India, P. westermani infection in humans remained undetermined. Herein, we report a case of pulmonary paragonimiasis due to P. westermani in an adult female in Manipur. The diagnosis was made by morphological and molecular characterisation of the eggs in the sputum. This is the fi rst confi rmed case of paragonimiasis due to P. westermani in India.

Phenotyping of Salmonella serotypes isolated from natural sources of water in rural areas of East Sikkim.

The objective of the study was to conduct bacteriological analysis of water with special reference to Salmonella spp from natural sources of rural habitations of East Sikkim. A total of 28 Salmonella serovars isolated were biotyped, phage typed and tested for their anti-microbial susceptibility. All the isolates of Salmonella enterica serovar Typhi belonged to Biotype I. Four isolates of S. typhi belonged to phage type A. All S. paratyphi A isolates belong to phage 2. All the isolates were sensitive to chloramphenicol, cefi xime and amikacin. Untreated natural water sources are unsafe for human consumption.

Common Infectious Etiologies of Acute Febrile Illness in a Remote Geographical Location: Could Scrub Typhus be the Most Common Cause?.

Background: Disease burden of acute febrile illness due to infectious etiologies is under reported in various parts of India including Sikkim due to lack of laboratory confirmation. Undifferentiated febrile illnesses common in tropical areas of Asia are dengue, chikungunya, malaria, leptospirosis, enteric fever, chikungunya, rickettsia, Japanese encephalitis and scrub typhus. Aims: This study was conducted to determine various infectious etiologies of acute febrile illness with their clinical presentations, complications and mortality with special emphasis to scrub typhus. Setting and Design: This was a cross-sectional study and 205 patients including paediatric patients admitted with acute febrile illness were evaluated. Materials and Methods: A detailed history was taken and complete physical examination was done in all patients. Basic laboratory tests were done in all cases along with confirmatory tests. Results: In our study the most common cause of acute febrile illness was found to be scrub typhus 74(36.1%) followed by dengue 25(12.2%), malaria10 (4.9%) and enteric fever 10 (4.9%). Sikkim is non endemic state for filariasis and visceral leishmaniasis. Interestingly in our study we found 2 cases (0.97%) of visceral leishmaniasis and 1(0.5%) case of filariasis. Conclusions: Scrub typhus was observed to be the common cause of acute febrile illness during the study period. Lack of diagnostic facilities makes scrub typhus an under-recognised cause of acute febrile illness in several parts of India even today. Although previously reported as occasional solitary cases from this region, this study witnessed the emergence of dengue as an outbreak in this region. Prompt recognition of acute febrile illness is important for specific treatment and better outcome in patients.

Paragonimus heterotremus infection in Nagaland: A new focus of Paragonimiasis in India.

PURPOSE: To determine the prevalence of paragonimiasis among the patients who were attending the tuberculosis (TB) clinics at the Community Health Centre, Pfutsero, Phek District, Nagaland. To determine the species of Paragonimus that cause infection in humans and the crustacean host that acts as the infectious source for humans. MATERIALS AND METHODS: Sputum specimens were examined microscopically for Paragonimus eggs and acid fast bacilli. Blood samples were tested by microenzyme-linked immunosorbant assay for Paragonimus-specific immunoglobulin G antibodies. Crab extracts prepared by digestion with artificial gastric juice were examined for Paragonimus metacercariae under a stereoscopic microscope. The species identification of the parasite was based on morphological and molecular characterizations of eggs and metacercariae employing polymerase chain reaction and DNA sequencing. RESULTS: Seven out of the 14 patients tested seropositive for paragonimiasis and Paragonimus eggs were detected in sputum of two out of the seven seropositive patients, indicating a prevalence of 50% and an egg detection rate of 14%, respectively. The prevalence was highest in the 10-30 year age group. More males got the infection than females, the ratio being 5:2. P. heterotremus was identified as the causative agent of human paragonimiasis and Potamiscus manipurensis as the crab host. CONCLUSIONS: The study revealed that paragonimiasis has been endemic in Pfutsero, Nagaland, and half of the patients attending the TB clinic were actually suffering from pulmonary paragonimiasis. This is the first confirmed report of an endemic focus of paragonimasis and description of P. heterotremus as the causative agent in Nagaland, India.

Clinico-etiologic correlates of onychomycosis in Sikkim.

AIMS AND OBJECTIVES: The etiological spectrum of any superficial mycosis is largely dependent on the flora in the immediate environment of the individual. It is influenced by the geographic, climatic and occupational factors. The study is basically to formulate baseline data for the species prevalence of various dermatophytes in patients with onychomycosis attending the Central Referral Hospital, Gangtok, Sikkim. MATERIALS AND METHODS: Thirty-four clinically suspected cases of onychomycosis were subjected to mycological studies. RESULTS: Thirty-two (94.12%) cases were positive for fungal elements by direct microscopy and 28 (82.35%) by culture. Young adults in the age group of 21-30 years were mainly affected. The male:female ratio was 1.125:1. Dermatophytes were isolated in 18 cases (64.29%). Trichophyton tonsurans (44.44%) was the most common isolate followed by T. mentagrophytes (22.22%), T. rubrum (11.11%), T. verrucosum (11.11%) and Microsporum audouinii (11.11%). Apart from dermatophytes, Aspergillus niger (21.43%) and Penicillium marneffei (14.28%) were also isolated. CONCLUSION: Dermatophytes, mainly T. tonsurans, as well as moulds other than dermatophytes were isolated from onychomycosis patients in Gangtok, Sikkim.

A case of paragonimiasis in a civet cat with a new Paragonimus sub species in Manipur, India.

A case of paragonimiasis in a civet cat with a new Paragonimus sub species in Manipur, India.

paragonimiasis in Manipur.

A survey was undertaken in the east district of Imphal valley of Manipur, India, using an intradermal test with saline extract of adult Paragonimus westermani as test antigen to find out the prevalence of paragonimiasis and some of the epidemiological factors attributable to it. A total of 3,467 individuals of both sexes aged five years and above were tested. A total of 2934 persons admitted eating crabs and among them 234 were found reactive to Paragonimus antigen. The prevalence rate observed was 6.7 per cent. The proportion of positive reactors (8.0%) among the crab eaters compared to 0.1 per cent among those who did not eat crabs was highly significant (P < 0.01). The difference in the prevalence rates in different age groups and different sexes was also found to be highly significant. The habit of eating raw and or undercooked crabs had significant correlation with skin reactivity. The intradermal test was found to be a good screening test for mass surveys due to its simplicity, low cost, high sensitivity and no known untoward reaction. Four persons among the skin positive reactors presented with cough, pain in the chest, recurrent haemoptysis as major clinical manifestations. Laboratory investigations revealed Paragonimus eggs in the sputum smears, raised erythrocyte sedimentation rate, and high absolute eosinophil count in their blood. Praziquantel, the drug of choice was given at a dose of 25 mg per kg body weight 3 times a day for three consecutive days to each patient for a cure.

COVID-19 pandemic: workplace readiness to control and contain the spread of coronavirus

The coronavirus outbreak has been declared a pandemic by the World Health Organization. It is a huge concern to both public and occupational health and is the biggest current threat to the global economy and financial markets. The aim of this paper is to highlight the key occupational health challenges based on available literature and to provide some guidance on preventive measures. A literature search was conducted on PubMed and Google for studies published from January to March 2020. Google translate was used for articles in foreign languages. The literature showed that healthcare workers are a high-risk group, although any worker is at potential risk. The key challenges identified relate to labour rights and sick leave, compensation, impact of quarantine on business continuity, and whether transmission is purely through droplets or if airborne transmission plays a role. The evidence, although limited, provides guidance for slowing down and reducing the risk of spread of the virus