Schizophyllum commune sinusitis in an immunocompetent host.

Schizophyllum commune is widely distributed in the nature, but it rarely causes human infection. We have isolated this mould in a 46-year-old immunocompetent, non-diabetic patient with chronic sinusitis, previously treated with multiple antibiotics and topical steroid nasal drops with no response. Materials obtained from the nasal sinus during the endoscopic surgery, on KOH mount and histopathological study revealed broad septed hyaline hyphae. Growth on the Sabouraud's dextrose agar and potato dextrose agar produced white moulds with microscopic and macroscopic characters of S. commune. Till date there are few reports of S. commune sinusitis in immunocompetent individuals Worldwide. This is the first reported case in India to the best of our knowledge.

Role of cell surface antigens of Vibrio cholerae 01 and non 01 serovars in intestinal adhesion.

Decrease in adherence of Vibrio cholerae to rabbit small intestine was observed following treatment with antisera against outer membrane (OM), lipopolysaccharide (LPS) and flagella. Anti LPS antibodies were more efficient than the other two antibodies in inducing adherence inhibition and promoting in vivo protection.

Prevalence of Helicobacter pylori infection in patients with reflux oesophagitis.

In this prospective study 30 patients of reflux esophagitis were studied to detect if there was any association between presence of esophagitis and H. pylori infection. 30 patients of non-ulcer dyspepsia acted as controls. In both the groups esophageal and antral biopsies were studied for the presence of H. pylori infection. None of the esophageal biopsies showed H. pylori infection in either group. H. pylori positivity was similar in the antrum of the patients with esophagitis (20 out of 30) and non ulcer dyspepsia (19 out of 30) (p > 0.05). There was no significant association between presence of H. pylori infection in antrum and severity of esophagitis (p > 0.05). In conclusion, this study has shown that H. pylori did not colonise esophagus in patients of esophagitis or patients of non-ulcer dyspepsia. There was no significant association between H. pylori colonization in the antrum and esophagitis and the grade of esophagitis with H. pylori infection.

Significance of antibody coated bacteria in neurogenic bladder cases.

A total of 85 urine samples from 63 patients with neurogenic bladder, were subjected for pus cell counting and culture. Fifty nine (69.4%) samples showing significant bacterial growth were tested for the presence of antibody coated bacteria (ACB). One serum sample per patient was collected for the estimation of C-reactive protein. E. coli was the commonest bacterial isolate (45.8%) from the clinical samples followed by Ps. aeruginosa (20.3%) and K. pneumoniae (18.6%). Thirty two culture positive samples belonging to 27 patients, were found to be antibody coated. Of all the isolates, K. pneumoniae was antibody coated in higher proportion (63.7%) followed by Ps. aeruginosa (58.3%) and E. coli (55.6%). Immunoglobulin G was found in all the ACB positive samples, where as 87.5% of them were also coated with IgA class of antibodies. All patients with ACB in urine had raised serum CRP levels except one, where as all the rest of the patients had CRP level within normal limit. The presence of pus cells in urine and radiological abnormalities in the urinary tract were significantly higher in ACB positive patients than in ACB negative patients.

Helicobacter pylori infection in patients with perforated duodenal ulcer.

AIM: Perforation is the commonest complication of duodenal ulcer. Helicobacter pylori is found in 95% patients with duodenal ulcer. However, there is paucity of reports on prevalence of H. pylori infection in patients with duodenal ulcer perforation. We, therefore compared the incidence of H. pylori infection in patients with duodenal ulcer perforation with the incidence in patients having complicated duodenal ulcers and non-ulcer dyspepsia. PATIENTS AND METHODS: The study was conducted on 45 patients (complicated duodenal ulcer 15, duodenal ulcer perforation 15, non-ulcer dyspepsia 15). Per-operative punch antral biopsies were taken in patients with duodenal ulcer perforation whereas endoscopic punch biopsies of antrum were taken in patients with non-ulcer dyspepsia. The criteria for H. pylori positivity was i) growth of H. pylori on culture, ii) combination of rapid urease test (RUT) and Giemsa staining, combination of RUT and Gram stain being positive for H. pylori. RESULTS: While 9 of 15 cases with complicated duodenal ulcer, 7 of 15 cases with non-ulcer dyspepsia were positive for H. pylori, none of the patients with duodenal ulcer perforation tested positive for H. pylori (p < 0.000). All patients with perforated duodenal ulcer had histological gastritis (H. pylori -ve). Fourteen of 15 patients (9 H. pylori +ve, 5 H. pylori -ve) with complicated duodenal ulcer and 9 of 15 patients (7 H. pylori +ve) with non-ulcer dyspepsia had histological gastritis. CONCLUSION: Patients with duodenal ulcer perforation do not have H. pylori infection. H. pylori negative patients of duodenal ulcer may have more predilection for perforation.

Western blot analysis of serological response in Helicobacter pylori in acid peptic diseases.

A prospective study was undertaken in 70 patients presenting with acid peptic disease with the objective of characterising the serological response to Helicobacter pylori and finding antigens specific for the serodiagnosis of H. pylori infection. H. pylori status was assessed by smear microscopy, rapid urease activity, culture and histopathology of endoscopic gastric antral biopsy specimens. Serological characterisation was carried out by using western blotting of various antigenic components of H. pylori and subsequent enzymatic detection of antibodies against them. Four reactive bands in the molecular weight range of 45-65 kDa were present in all subjects irrespective of H. pylori status. Four to six immunoreactive bands in the molecular weight range of 21-45 kDa were found only in patients with positive H. pylori status and histopathologically proven gastritis. These immunoreactive components may be valuable in specific immunodiagnosis of H. pylori infection.

Infection rates in single- and double-lumen central venous catheters in critically ill patients.

BACKGROUND. Catheter-related sepsis is a well known complication in critically ill patients receiving total parenteral nutrition. Micro-organisms may travel from the skin puncture wound along the external surface of the catheter or from the hub through the lumen of the catheter, to be shed into the circulation causing bacteraemia and sepsis. The incidence of sepsis is said to be about three times greater with multiple-lumen catheters than with single-lumen catheters. METHODS. Fifty patients admitted to our intensive care unit were randomly assigned to have either a single-lumen (Group I, 25 patients) or double-lumen (Group II, 25 patients) hydromer-coated, polyurethane central venous catheters of the same gauge and length, placed through the infraclavicular subclavian approach using the Seldinger technique. A sterile dry gauze dressing at the skin puncture site was changed every day. Skin swabs were taken for semi-quantitative culture studies before catheter insertion and removal, from the proximal 3 cm (lying subcutaneously) and distal 5 cm of the catheter segments on removal of the catheter, and venous blood was drawn from a peripheral vein before removal of the catheter. RESULTS. The most common isolate was coagulase negative Staphylococcus. No significant difference was found between the two groups in the incidence of catheter-related infection and catheter-related sepsis. CONCLUSION. Double-lumen central venous catheters placed in critically ill patients do not cause more sepsis than single-lumen catheters.

Allergic bronchopulmonary aspergillosis: a retrospective study of 35 cases.

Clinical profile of 35 patients with allergic bronchopulmonary aspergillosis (ABPA) was analysed. The disease was found to be more frequent among females. Constitutional symptoms, expectoration, increased breathless and poor control of asthma were the main presenting features. Skin reactivity against aspergillin and Candida was positive in 30 and 2 cases, respectively. Precipitating antibodies against Aspergillus species was positive in 28 cases, and against Candida albicans in 2 cases. Sputum grew either Aspergillus or C. albicans or both in 19 patients. Absolute eosinophilia was observed only in one third of cases. Chest skiagram revealed characteristic central/proximal bronchiectasis and/or fleeting shadows in all cases. No specific pattern was observed on spirometry. There was no correlation between the duration of bronchial asthma, sputum culture and serology results. Most patients responded well to steroids. One striking feature of the study was that one third of the cases were misdiagnosed as pulmonary tuberculosis and were treated with antitubercular drugs for varying periods of time. A high index of clinical suspicion with appropriate laboratory tests are required to identify these cases.

A cholera-coli related enterotoxin production by different Shigella species.

A cholera-coli related enterotoxin production was studied in 50 different Shigella isolates from cases of childhood diarrhoea. Four out of 6 Sh. dysenteriae, 18/37 Sh. flexneri and 2/4 Sh. sonnei were found to be enterotoxin producers by RIL test. All strong RIL positive strains were isolated from cases of severe diarrhoea, indicating the association of enterotoxin production and severity of acute diarrhoea. Two major protein bands were observed in SDS-PAGE and W.B. EIA assay in all positive RIL extracts. These immuno-reactive bands were at 31 kDa and 14 kDa positions resembling A-B subunit structure of cholera-coli family of enterotoxins.

Identification of Helicobacter pylori by endoscopic crush cytology.

BACKGROUND: Gastric crush cytology is employed in a variety of situations including diagnosis of malignant disease and the detection of Helicobacter pylori infection. OBJECTIVE: To evaluate the usefulness of gastric crush cytology in the detection of H pylori infection. METHODS: Gastric biopsy specimens from 50 patients of gastric or duodenal peptic ulceration were studied by gastric crush cytology, histopathology, bacteriologic culture and rapid urease test and results of various methods compared. RESULTS: Thirty seven patients had H pylori demonstrable in crush smears and 28 in histopathological sections. In 15 patients, the organism was detected by cytology alone and in 6 samples by histopathology alone. There was concordance of 76% between these two morphological techniques. The organism could be cultured from 22 biopsy specimens and urease test was positive in 37 specimens. CONCLUSION: Gastric crush cytology is a useful method for detection of H pylori infection.

Pre- & post-fumigation bacteriological surveillance of hospital environment.

Study of bacteria in the environment and surfaces of hospital wards revealed Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus faecalis, Acinetobacter species, coagulase negative staphylococci and Serratia marcescens to be the predominant bacterial isolates. Surface sampling following fumigation showed significant reduction in most of the isolates. Bacterial counts in the air also showed considerable decline. Fumigation under proper technical supervision showed significant reduction in bacterial count as compared to that carried out without such supervision. This study highlights that certain bacterial species are predominantly found in the hospital environment and emphasises the need for frequent supervisory monitoring of hospital wards.

Multiple drug resistance and genetic characterization of Salmonella typhimurium isolated at Chandigarh.

A total of 1072 strains of S. typhimurium were isolated in Chandigarh during 1985-1988. Genetic characterization of 'R' plasmids was attempted in 21 multiple drug resistant strains (ACKSSu TT p-19, ACKSSu, TP-I, AKSSu Tp-1). All the 21 strains were sensitive to gentamicin, furoxone and nalidixic acid. Level of resistance to different antimicrobial drugs varied from 200 to 1000 mg/L. Majority of the strains were untypable by the present set of 31 typing phages (Ut-17, Phage type 21-2, Phase type 99-2). All the plasmids belonged to class I transfer system. All the plasmids restricted some or all the typing phages of S. typhimurium and 39 also restricted phage phi 2. These plasmids belonged to F1me or I1 incompatibility groups and did not inhibit the function of fertility factor (fi-).

Effect of blockade of transdiaphragmatic absorption of bacteria on survival in peritonitis: an experimental study in rats.

An experimental rat model of established peritonitis was used to test the effect of intraperitoneal injection of platelet rich plasma (PRP) on blood and peritoneal fluid culture positivity and survival rates. Thirty animals divided into two groups of 15 each were studied. The first group served as control while animals in the second group received intraperitoneal injection of PRP. The use of PRP in established. Peritonitis was of no significant benefit.

Salmonella typhimurium enterotoxin mediated fluid secretion.

Unidirectional Na+ and Cl- fluxes were studied in rats treated with S. typhimurium enterotoxin (S-LT). There was net absorption of Na+ and Cl- in the control group, while in the toxin treated animals there was net secretion of Na+ and Cl- (P less than 0.001). There was no change in the transport of D-glucose in the toxin treated group as compared to the control animals. The Na+, K(+)-ATPase pump was unaltered in the S-LT treated animals (198.67 +/- 11.23 nmoles Pi/mg protein/min) as compared to the control group (189.93 +/- 10.09 nmoles Pi/mg protein/min). There was no change in the unidirectional fluxes of Ca+2 in the S-LT treated animals as compared to the control animals, suggesting no change in the permeability of the S-LT treated intestinal membrane to Ca+2.

Enterotoxigenic Klebsiella pneumoniae in acute childhood diarrhoea.

K. pneumoniae strains recovered as pure or predominant isolate from stool specimens of 50 children below three years of age, presenting with acute watery diarrhoea, were studied for heat-labile enterotoxin production. Twenty three (46%) of the 50 crude toxin concentrates showed positivity in rabbit ileal loops and skin permeability tests. Antigenically 17 (34%) and 20 (40%) of the toxin extracts reacted with immuno-purified anti H-LT antibody in latex particle agglutination and immuno-dot blot assays respectively. Polyacrylamide-gel electrophoresis, Western-blotting and enzyme-immunoassay revealed heat-labile enterotoxin and its subunits in 19 (68%) of 28 extracts tested. In 5 of 10 strains tested the toxigenicity could be transferred to recipient Escherichia coli J-35 in plasmid transfer experiments. Klebsiella induced enterotoxigenic diarrhoea and produced a heat-labile toxin which seems to be biologically, antigenically and possibly genetically related to the heat-labile toxin of the cholera-coli family.

Enterotoxin production & mouse virulence of clinical isolates of Salmonella typhimurium strains.

Twenty five isolates of S. typhimurium from clinical specimens were studied for markers of virulence. Three of five isolates from blood, both isolates from CSF and urine and only two of fifteen isolates from faeces were positive for fluid accumulation in rabbit ileal loop. All these strains produced an enterotoxic principle, antigenically related to cholera coli family of enterotoxins, as detected by latex agglutination and immuno-dot-blot tests. Polymyxin-B treated 6 h cultures yielded the best toxin. All 5 blood isolates, both CSF isolates and one of the two urine isolates showed low LD50 indicating high virulence. The study thus revealed that some strains of S. typhimurium are more virulent and produce more enterotoxins. These strains invade the intestinal mucosa potently and lead to extra-intestinal manifestations. The low virulent strains, on the other hand, are confined to the intestine and cause mild/moderate gastroenteritis. Enzyme assays were done in 5 representative strains of good, moderate and low toxin producers. Catalase and superoxide dismutase assays did not show any correlation with toxin production, thus suggesting that the enzyme production is unlikely to be a reliable indicator of the virulence for S. typhimurium.

Outbreak of Salmonella worthington meningitis & septicaemia in a hospital at Chandigarh (north India).

During August 1988 an outbreak of hospital acquired infection due to S. worthington has been reported at the Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh. A total of seven neonates presented with the clinical features of meningitis and septicaemia during this outbreak and six babies died. S. worthington was isolated from blood and cerebrospinal fluid respectively. The same strains were isolated from the baby warmer mattress, baby cot, suction machine bottle and wall of the fridge. Samples from doctors, nurses and apparently healthy babies born during this period did not grow the above organism. This appears to be the first report on S. worthington in human beings from India. The outbreak was controlled by thorough cleaning and fumigation. The organisms were also mostly sensitive to antibiotics used, in contrast to the multiple drug resistant pattern reported from elsewhere.