Disseminated Histoplasmosis in an Immunocompetent Patient from a Non Endemic Region, North India: Pointers to Potential Endemicity.

Progressive Disseminated Histoplasmosis (PDH) reported worldwide is yet a rare entity in India. Although, usually associated with an underlying immunocompromised state but few reports of this disease in non- immunocompetent individuals have been surfacing in last decade. We report PDH from Himalayan state of Uttarakhand North India in an agriculturist, non immunocompromised who responded well to treatment with no evidence of recurrence of the disease. Of late a number of cases are being reported from this region, an indication that this might be a hot spot of Histoplasma capsulatum.

Diagnostic role of MGIT culture of BAL samples in sputum smearnegative pulmonary tuberculosis.

Background: In view of the diagnostic difficulties associated with sputum- negative pulmonary TB (PTB), we aimed at exploring if bronchoalveolar lavage (BAL) samples can be subjected to smear- microscopy and rapid mycobacterial culture (by Mycobacterial Growth Indicator Tube (MGIT) method) to achieve improved diagnosis of this condition. Methods: Patients presenting with clinico-radiological features suggestive of pulmonary tuberculosis and whose sputum smears were negative for acid- fast bacilli (AFB) or who could not expectorate sputum were prospectively enrolled in this study. BAL samples collected from them were subjected to smear- microscopy for AFB and micro-MGIT culture. BAL samples were also inoculated on Lowenstein- Jensen (LJ) slants. Results: A total of 105 patients (74 males) were recruited in the study, with a mean (±SD) age of 51 (± 15) years. The diagnosis of PTB was made in 52 patients on the basis of clinico- radiological presentation, with or without microbiological confirmation. Thirty- four patients (65.4 %) had microbiologically confirmed PTB. Of them, AFB were detected in 12 BAL samples, while culture- positivity was noted in 24 and 27 patients by the LJ and MGIT methods respectively. Intertest agreement between the LJ and MGIT methods was found to be significant (ê= 0.655; p= <0.001). However, the mean time to positivity was significantly lower for the MGIT method than for the LJ method (p= <0.001). Conclusion: Examination of BAL samples by smear- microscopy and micro-MGIT culture can, therefore, provide a rapid and definitive diagnosis of PTB in sputum- negative patients.

Choice of antibiotic for empirical therapy of acute cystitis in a setting of high antimicrobial resistance.

BACKGROUND: A high prevalence of antimicrobial resistance among urinary isolates in the Garhwal region of Uttaranchal. AIMS: To identify the most appropriate antibiotic for empirical treatment of community-acquired acute cystitis on the basis of local antimicrobial sensitivity profile. SETTINGS AND DESIGN: A prospective clinico-microbiological study including all clinically diagnosed patients with community acquired acute cystitis attending a tertiary care teaching hospital over a period of three years. METHODS AND MATERIAL: Clean-catch midstream urine specimens, from 524 non-pregnant women with community-acquired acute cystitis, were subjected to semi-quantitative culture and antibiotic susceptibility by the Kirby- Bauer disc diffusion method. A survey was also conducted on 30 randomly selected local practitioners, to know the prevalent prescribing habits in this condition. STATISTICAL ANALYSIS: The difference between the susceptibility rates of E. coli isolates to Nitrofurantoin and the other commonly prescribed antibiotics was analysed by applying the z test for proportion. RESULTS: 354 (67.5%) specimens yielded significant growth of E. coli.> 35% of the urinary E.coli isolates were resistant to the fluoroquinolones, which were found to be the most commonly used empirical antibiotics in acute cystitis. Resistance was minimum against Nitrofurantoin (9.3%, 33) and Amikacin (11.0%,39).> 80% of the fluoroquinolone-resistant strains were found to be sensitive to Nitrofurantoin. CONCLUSION: The best in vitro susceptibility profile in our study has been shown by Nitrofurantoin and a significantly high proportion of the urinary E. coli isolates have already developed resistance to the currently prescribed empirical antibiotics, viz. the fluoroquinolones. In view of these in vitro susceptibility patterns, a transition in empirical therapy appears imminent.

A clinicomicrobiological study on the importance of pseudomonas in nosocomially infected ICU patients, with special reference to metallo beta1-lactamase production.

The present study was conducted with a view to assess the burden of pseudomonal infection in ICU patients of a tertiary care teaching hospital in Uttaranchal. Of the 525 patients selected for the study, during a 1-year period, 60 patients developed features of nosocomial infection and among them Pseudomonas was isolated from one or more samples in 18 patients. The isolated strains were speciated and further characterized for determining their antibiogram and for production of beta-lactamase, extended spectrum beta-lactamase and metallo-beta-lactamase enzymes. Pseudomonas aeruginosa was the commonest species isolated (54.54%) and endotracheal suction material showed the highest bacterial yield. Polymyxin B was found to be the most effective antibiotic followed by imipenem and carbenicillin. Though no strain was found to be producing beta-lactamase and extended spectrum beta-lactamase enzymes, a total of 12 strains (54.54%) were metallo-beta-lactamase producers. For all the beta lactam antibiotics, excepting aztreonam, the metallo-beta-lactamase producers showed more resistance compared to the non-producers.

Antimicrobial susceptibility pattern of bacterial isolates from post-operative wound infections.

516 bacterial isolates were obtained from 502 pus samples, collected from post operative wound infections. Staphylococcus aureus (n=166) was the most frequently isolated bacteria followed by Escherichia coli (n=114), Pseudomonas aeruginosa (n=65), Acinetobacter (n=43), Klebsiella pneumoniae (n=29) and others. Majority of the isolates were resistant to ampicillin, ampicillin-clavulanic acid, cephelexin, cefuroxime, cefotaxime, fluoroquinolones and cotrimoxazole. Alarming antimicrobial resistance made it imperative that measures for control be taken with special emphasis on formulation and implementation of antibiotic policy.