Antimicrobial Utilization Study in a Neurology Setting

Background : Measuring antimicrobial consumption is necessary to understand the volume and patterns of use, to design appropriate interventions to reduce and rationalize its use. Materials and Methods : The antimicrobial consumption in Neurology ICU and IPD were measured over a 5-year period using WHO Defined Daily Dose (DDD) methodology. Results : There was an increasing trend in Antimicrobial Consumption (AMC) from 125.7 to 155.5 DDDs/100 days over 5 years with highest consumption in 2017-2018 (190.7 DDDs). The consumption of Watch group of antibiotics was higher than access group antibiotics both in ICU and IPD and constituted more than 75% of total antibiotic consumption. Conclusions : The initiation of empiric therapy though may be necessary depending on the patients condition, however, duration of antibiotic therapy and reducing usage of prophylactic antibiotics for aspiration pneumonia and reducing consumption of Watch group of antibiotics were identified as stewardship opportunities. Feedback on AMC data and persuasive educational interventions to rationalize and reduce antimicrobial use are required.

Isolated myocysticercosis: rare presentation in quadriceps muscle

Myocysticercosis is not a common disorder and in particular quadriceps muscle is rarer. We are reporting this rare case of myocysticercosis involving quadriceps muscle of right thigh with ultrasonographic demonstration of nodular scolex and associated edema with no neurological involvement.

Utility of GenoType MTBDRPlus Assay for Direct Detection and Drug Susceptibility Testing of Mycobacterium tuberculosis from Probable Tuberculous Meningitis Patients.

Aims: To evaluate GenoType® MTBDRplus line probe assay as a diagnostic tool for detection of Mycobacterium tuberculosis and drug susceptibility testing from cerebrospinal fluid of probable tuberculous meningitis patients. Study Design: A prospective, double blind study. Place and Duration of study: Dept. of Microbiology and Neurology, Institute of Human Behavior and Allied sciences, Delhi, India between February 2014 to October 2014. Methodology: Cerebrospinal fluid collected from 107 probable meningitis patients with diagnostic score >10 were subjected to smear microscopy, automated liquid culture (BACTEC MGIT 960) and Polymerase chain reaction (IS6110). All the samples were also subjected to GenoType® MTBDRplus line probe assay for detecting M. tuberculosis and drug susceptibility. Drug susceptibility testing of all the M. tuberculosis isolates was done by BACTEC MGIT 960 and GenoType® MTBDRplus line probe assay. Results: The sensitivity, specificity of the assay for M. tuberculosis detection was 49.5%, 100% against clinical diagnosis as reference standard and 68.9%, 100% against definitive diagnosis as reference standard. A diagnostic accuracy of 56.8% (kappa 0.22), 75% (kappa 0.46), were seen in patients with probable and confirmed diagnosis respectively. The drug susceptibility results for Isoniazid and Rifampicin could be delineated in only 39.2% of patients. Conclusion: This assay proved to have better sensitivity, diagnostic accuracy than smear microscopy and automated liquid culture for early detection of M. tuberculosis from probable tuberculous meningitis patients and has comparable sensitivity to culture (39.2%) for detection of drug susceptibility (though on different isolates). Rapid turnaround time and user friendliness makes it an acceptable assay for simultaneous early detection of M. tuberculosis and its drug susceptibility for better patient management.

Prevalence of HIV-associated cryptococcal meningitis and utility of microbiological determinants for its diagnosis in a tertiary care center.

CONTEXT: Human immunodeficiency virus (HIV) infection continues to be the most important risk factor for the development of central nervous system (CNS) cryptococcosis, which in turn is an important contributor to morbidity and mortality in HIV-infected patients. Early diagnosis of such patients is the key to their therapeutic success. AIMS: This study was undertaken to find out the prevalence of CNS cryptococcosis and to assess the role of microbiological parameters for its specific diagnosis in HIV-reactive hospitalized patients admitted with meningeal signs in a tertiary care setting. MATERIALS AND METHODS: A total of 104 patients suspected to be suffering from meningitis/meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including India ink preparation, culture by conventional methods and Bactec MGIT 960 system, antigen detection) and tests for HIV antibodies by standard laboratory operating procedures. RESULTS: The prevalence of HIV infection in our study group was 12.5% (13/104), while the prevalence of cryptococcal CNS infection in HIV-reactive cohort was 46% (6/13). Additionally, 15.3% (2/13) of the patients from this cohort were positive for Mycobacterium tuberculosis. CONCLUSIONS: High prevalence of cryptococcal CNS infections in HIV-infected patients underscores the importance of precise and early microbiological diagnosis for better management of such patients.

Uncommon Neurological Presentation due to Non-Ketotic Hyperglycemia (NKH) –Report to two cases.

Two patients of uncommon neurological presentation due to non-ketotic hyperglycemia (NKH) are being described in this report. Generalized choreo-athetosis and epilepsia partialis continua as presenting symptoms in non-ketotic hyperglycemia is rare. The abnormal movements responded completely to insulin therapy. In acute onset of abnormal movements, besides other causes, metabolic disorders such as non-ketotic hyperglycemia should also be ruled out as they are treatable.

Post-traumatic dissecting aneurysms of bilateral cervical carotid arteries with delayed complications.

Carotid dissection is an uncommon complication of trauma. They can present with immediate or delayed complications. We describe the case of a young patient with bilateral carotid dissections and acute infarcts. Brief review of literature and treatment options are discussed.