Evaluation of Various Non Culture Methods for the Diagnosis of Spontaneous Bacterial Peritonitis

Introduction: Spontaneous Bacterial Peritonitis (SBP) iscommon and serious complication of patients with livercirrhosis and ascites, without an apparent surgically treatableintra abdominal source of infection. Its prevalence rangesfrom 10% to 30%. Mortality rate was earlier reported morethan 90%, but it has now reduced to 30% -50% as a resultof rapid diagnosis and prompt initiation of antibiotics. Thepresent study was done to evaluate the various non culturemethods for the diagnosis of SBP.Material and Methods: Ascitic fluid sample were collectedaseptically from 100 cirrhotic patients with ascites. PMN(polymorphonuclear leukocyte) count was determined byNeubauer’s manual counting chamber and Leishman’s stainfor differential PMN cell counts. Granulocyte esterase activitywas detected using LER (Leukocyte esterase reagent) dipstickstrips.Results: Out of 100 samples processed, PMN cell count >250 cells/mm3 was found in 91% samples by conventionallight microscopy. Scale of > 2+ by LER strip was found in61 samples. Reading of PMN cell count of > 250 cells/mm3matched in 60 samples and < 250 cells/mm3 matched in 8 cellsby both microscopy and LER strip test. Sensitivity, specificity,positive predictive value and negative predictive value ofLER strip test was 65.9%, 88.89%, 98.36% and 20.51%respectively.Conclusion: LER strips as a screening tool for SBP haveadvantage of speed, low cost, availability at odd hours, requiresno technical expertise and can be performed everywhere.Its high specificity and PPV may help in early institution ofempirical antibiotic therapy in patients.

Evaluation of microbiocidal activity of superoxidized water on hospital isolates.

Background: Prevention of nosocomial infections, pre-operative and post-operative complications is directly linked with effective disinfection and decontamination. Microbial decontamination is the most serious challenge to the today's health care practice despite the abundance of disinfectants and chemicals as there are increasing reports of emergence of resistance to the action of commonly used disinfectants. There is a need to evaluate the efficacy of newer methods of asepsis for better patient management. Aim: This study was designed to evaluate the microbiocidal activity of superoxidized water (SOW) on common clinical isolates, ATCC strains, vegetative cells and spores of Bacillus subtilis. Materials and Methods: Bacterial suspensions were treated with SOW and deionized water (control). All the tubes were incubated at 37°C for 0.5, 2.5 and 5.0 min. The number of viable cells was counted. Results: All the clinical isolates and ATCC strains were killed within 0.5 min of exposure to the SOW. Vegetative cells and spores of B. subtilis were killed after 5.0 min. Conclusion: We conclude that SOW is an effective microbiocidal agent for routine hospital use.

Emergence of VRE and their antimicrobial sensitivity pattern in a tertiary care teaching hospital

During the last few years enterococci have emerged as an important cause of nosocomial and community acquired infection. They have acquired resistance to commonly used antibiotics including glycopeptides posing challenge to therapeutic options. The aim of this study was to investigate the prevalence and sensitivity of VRE to newer drugs. A total of 250 strains of E. faecalis were isolated using conventional scheme of Facklam and Collins. High level aminoglycoside resistance (HLAR) was detected by disc diffusion method using 120 ìg gentamicin disc and confirmed by agar dilution screen method. Screening for vancomycin resistance was done by disc diffusion and the agar screen method, and was further confirmed by broth dilution method for minimum inhibitory concentration (MIC). The strains which were resistant to vancomycin were further tested for sensitivity to newer and commonly available antibiotics. Maximum number of enterococcal isolates were recovered from urine (32.8 por cento) followed by blood (25.6 por cento) and pus (18.4 por cento). Penicillin (83.6 por cento) and cotrimoxazole (77.9 por cento) were found to be least effective drugs against the E. faecalis whereas; cefuroxime (76.8 por cento) and vancomycin (98 por cento) were most effective drugs in vitro. About two percent isolates of enterococci were resistant to vancomycin. All the VRE isolates were sensitive to quinupristin/dalfopristin. Linezolid and chloramphenicols were the two other in vitro effective drugs with 80 por cento sensitive isolates. MIC of all the VRE isolates was found to be in range of 64-512ìg/mL. So, quinupristin/dalfopristin can be used for infections caused by VRE. Continuous surveillance is necessary to detect early outbreak, and spread of VRE.

Human papillomavirus and skin tags: is there any association?

BACKGROUND: Low-risk human papillomavirus (HPV) infections are related to the genesis of various benign lesions. In an isolated report available, HPVs have been implicated in the causation of skin tags too. AIMS: The present study was designed to detect the existence of low-risk HPV types 6 and 11 in cutaneous soft fibromas (skin tag) in north Indians. METHODS: A total of 37 cases of skin tags from various sites were analyzed. Highly sensitive and comprehensive polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) assays were done for the detection of low-risk HPV types 6 and 11. RESULTS: The results revealed the presence of HPV DNA 6/11 in 48.6% of the skin tags examined by PCR-RFLP. CONCLUSION: This result corroborates the hypothesis that HPV plays a part in the etiology of benign lesions like cutaneous soft fibromas. The identification of HPV 6/11 in these lesions, which are benign proliferations of the skin, further expands the spectrum of HPV-linked lesions.

Detection of extended-spectrum beta-lactamase in Pseudomonas aeruginosa.

PURPOSE: The present study was designed to detect the extended-spectrum beta-lactamase (ESBL) production in Pseudomonas aeruginosa and to evaluate the susceptibility pattern. MATERIALS AND METHODS: One hundred forty-eight isolates of P. aeruginosa were analyzed for the presence of ESBL enzyme by double disc synergy test. Antibiotic sensitivity pattern of ESBL-positive P. aeruginosa was determined. RESULTS: Of the 148 isolates tested, 30 (20.27%) were found to be positive. Maximum ESBL production was found in sputum and tracheostomy swabs (28.57%), followed by pus (24.13%), urine (19.04%), cerebrospinal fluid (CSF) and other sterile body fluids (15.38%) and blood (7.14%). All the ESBL-producing P. aeruginosa isolates were multi-drug-resistant. Isolates were 100% sensitive to imipenem. Ofloxacin was the second most (70%) effective drug. CONCLUSION: From this study, we conclude the presence of ESBL-positive P. aeruginosa in our hospital. This has important implications as carbapenems remain the only choice of treatment for infections caused by these organisms. The control measures include judicious use of antibiotics and implementation of appropriate infection control measures to control the spread of these strains in the hospital.

Adrenocortical carcinoma: diagnosis by fine needle aspiration cytology.

Two cases of adrenal cortical carcinoma are described, wherein the diagnosis was established by fine needle aspiration cytology (FNAC). FNAC is increasingly being accepted as a means of diagnosis of adrenal cortical carcinomas. In yester years the diagnosis was established largely on post-operative histopathology. Adrenal cortical carcinomas are rare and account for less than 0.05% of all malignant neoplasms. Adrenal gland has become frequent target of needle biopsies with the availability of sensitive imaging techniques and better localization. Currently, needle biopsy is the only non-surgical means of obtaining a diagnosis in patient with adrenal mass. We present two cases of adrenal cortical carcinoma diagnosed on fine needle aspiration cytology (FNAC).

Xanthogranulomatous oophoritis and salpingitis: late sequelae of inadequately treated staphylococcal PID.

We describe the case of a 42-year-old woman who was a follow-up case of incompletely treated pelvic inflammatory disease, and presented with menorrhagia and bilateral ovarian masses. Subtotal hysterectomy with bilateral salpingo-oophorectomy was performed. Purulent material was obtained from the cystic masses, which grew Staphylococcus aureus. Histological examination of right-sided cystic mass revealed a simple cyst of the ovary. Left sided tuboovarian mass revealed the presence of lipid filled macrophages with lymphocytes, plasma cells and neutrophils; this established the diagnosis of xanthogranulomatous salpingitis and oophoritis. The case is of interest in view of the rarity of this condition; five cases of xanthogranulomatous salpingitis and oophoritis have been reported in the world literature till date.

Bacteraemia in children.

OBJECTIVES: (i)To know the etiology of bacteraemia in children, (ii) To learn the antibiotic sensitivity pattern of the isolates. METHOD: Over the period of thirteen months 4,368 blood samples (for blood culture) were collected from children in the age group of 0 day-14 years, suspected of having fever and sepsis. Blood samples were collected for blood culture from each case. Organisms were isolated and identified by conventional methods. Antibiotic susceptibility for each isolate was determined by using modified Stokes method. RESULT: 1,001 cases (22.9%) were culture positive. Incidence of bacteraemia in neonates was 521(33.94%). Gram negative organisms were the most predominant isolates (88.8%). Commonest was Klebsiella 471 (47.1%) followed by Salmonella sp. 162 (16.2%) and Pseudomonas 80 (8%) whereas in gram positive, Staphylococcus aureus 76 (7.6%) was the most common. Maximum sensitivity was seen by sulbactum/cefaperazone combination-969 (98.2%) by all isolates. Linezolid 97 (99.0%) was the most sensitive drug for gram positive isolates. CONCLUSION: Gram negative multidrug resistant organisms were the main cause of septicemia in all the age groups. Therefore great caution is required in selection of antibiotic therapy.

Trichinosis of psoas muscle.

There are isolated case reports of Trichinella spiralis infestation in animals from India. We report the first case in man from India. The nematode was discovered incidentally during drainage of psoas abscess.