Evaluation of the usefulness of phage amplification technology in the diagnosis of patients with paucibacillary tuberculosis.

The present study was undertaken to assess the performance of the Fast Plaque TB(TM) (FPTB) test in the diagnostically difficult group of paucibacillary tuberculosis (TB) and to compare its results with the conventional bacteriological methods. The study was conducted on a total of 139 patients, who were negative for TB in sputum-smear examination. Bronchoalveolar lavage (BAL) or pleural biopsy specimens collected from these patients were subjected to smear examination, LJ culture and FPTB test. The smear, culture and the FPTB positivity rates were compared between patients with pulmonary and pleuro-pulmonary involvement. The FPTB test was found to register an overall sensitivity of 58.8% and specificity of 97.9%. The positive and negative predictive values of the test were 98.1 and 56.5, respectively. Among patients with paucibacillary TB, on head-to-head comparison, we found that the sensitivity and specificity values of the FPTB test were marginally better than smear-microscopy and inferior to culture on LJ media.

Phage typing, biotyping & antimicrobial resistance profile of Salmonella enterica serotype Typhi from Kolkata.

BACKGROUND & OBJECTIVE: Kolkata and its suburbs in eastern India are known to be endemic for typhoid fever. The objective of this study was to determine phage types, biotypes and antimicrobial resistance patterns of Salmonella enterica serotype Typhi isolated during the period 2003-2005 from a prospective surveillance for typhoid fever in two urban slums in Kolkata. METHODS: A total of 195 Salmonella enterica serotype Typhi isolated from blood cultures were phage typed, biotyped and tested for their antimicrobial susceptibility profile. RESULTS: Phage type E1 was the most common (60.3%) followed by phage type A among five phage types identified. Biotype I (95%) was predominant, 28 isolates were multidrug resistant (MDR) and most of the MDR strains belonged to phage type E1 and biotype I. INTERPRETATION & CONCLUSION: A single phage type and biotype were prevalent among the Salmonella enterica serotype Typhi isolates studied from Kolkata, India.

Epidemiological, microbiological & electron microscopic study of a cholera outbreak in a Kolkata slum community.

BACKGROUND & OBJECTIVE: Epidemics of cholera caused by Vibrio cholerae O1 or O139 have been reported from different parts of India. Factors such as unsafe water supply, poor environmental sanitation, indiscriminate defaecation and lack of personal hygiene are mainly responsible for continued transmission of this disease. We report here epidemiological and microbiological findings of a localized outbreak of cholera, which occurred during March and April 2004 in the eastern part of Kolkata city. METHODS: The affected slum area has a population of 4409, predominantly muslims. Patients suffering from acute watery diarrhoea attended the health outposts organized by National Institute of Cholera and Enteric Diseases, Kolkata and International Vaccine Institute, South Korea as part of a routine surveillance programme at the locality as well as the emergency medical camp organized by the Kolkata Municipal Corporation. Stool and water samples were collected and tested for diarrhoeagenic pathogens in the laboratory. Bacteriophages specific for V. cholerae were isolates and studied electron microscopically for morphology. RESULTS: A total of 89 diarrhoea cases were reported giving an attack rate of 2 per cent. V. cholerae O1 biotype ElTor, serotype Ogawa was isolated as a sole pathogen from 15 (15.8%) of 89 stool samples screened. Water samples (2 from tube wells, 3 from municipal taps and 1 from well) showed presence of coliform bacilli with high MPN (Most Probable Number) count. Bacteriophages specific to V. cholerae were isolated from 2 of 6 water samples examined. A leakage was detected in the main pipeline supplying drinking water to that area. INTERPRETATION & CONCLUSION: The outbreak was caused by V. cholerae O1 (Ogawa) biotype ElTor. The presence of phages in the water samples was an additional indicator for V. cholerae contamination in this community. Occurrences of such outbreaks support vaccination against cholera as an alternative strategy.

Wood-smoke exposure: an unusual cause of miliary mottling on X-ray chest.

A case of wood smoke inhalation related lung disease presenting with miliary mottling on radiography is described. Transbronchial lung biopsy showed the presence of coal macules.

Mediastinal widening in a patient of ulcerative colitis.

A case of ulcertaive colitis on long-term corticosteroid therapy presenting with mediastinal widening and diagnosed to have mediastinal lipomatosis an thoracic computed tomography is presented.

Outbreak of cholera caused by Vibrio cholerae 01 intermediately resistant to norfloxacin at Malda, West Bengal.

During the end of September 1997, an unusual outbreak of severe dehydrating watery diarrhoea cases and deaths were reported from Malda town. Vibrio cholerae 01 El tor, the causative agent responsible for this episode was isolated from 56.5% of cases sampled. Three of the five drinking water samples were also positive for V cholerae 01. Majority of cases were adults. Isolated strains were uniformly resistant to furazolidone and intermediately to norfloxacin. Indiscriminate use of antibiotic should be discouraged for development of multidrug resistant strains.

Uncooked rice powder in oral rehydration solution: an alternative to glucose or cooked rice powder.

Glucose-based or rice-based ORS is the standard treatment in acute dehydrating diarrhoea. However, glucose may not be easily available in remote villages and the rice needs to be cooked for rice-based ORS. We embarked on a study to examine whether uncooked rice powder could be used as an alternative to glucose or cooked rice powder in ORS. Initially, 50 adult male patients (aged 18 to 55 yr) were randomized to receive glucose-ORS or uncooked rice ORS, in two equal groups. Subsequently, 20 male children (aged 3 to 12 yr) were also enrolled in the study and received either WHO-ORS or study ORS. All the adult patients and the children could be successfully rehydrated with ORS containing uncooked rice powder. As compared to WHO-ORS, the study ORS significantly reduced stool output (6.60 +/- 1.24 vs. 5.88 +/- 1.34 l), ORS intake (9.17 +/- 1.54 vs 8.24 +/- 1.69 l) and duration of diarrhoea (45.68 +/- 6.91 vs 41.32 +/- 6.03 h). In children also similar results were obtained. No clinical complication (e.g., vomiting, abdominal pain etc.) or abnormality in serum electrolyte concentrations was encountered either in the adults or in the children. Uncooked rice powder containing ORS can be considered as an alternative to glucose-based ORS or rice-based ORS.

Incidence of hepatitis B virus (HBV) infection amongst clinically diagnosed acute viral hepatitis cases and relative risk of development of HBV infection in high risk groups in Calcutta.

The present study revealed that 30.5% of acute infective hepatitis were due to the infection of Hepatitis B virus (HBV) however, 8% controls also showed HBV positivity. The possible route of infection of HBV in our country were Parenteral in 51.9%, Sexual in 24% and Unidentified in 24.1% cases. HBV marker positivity was 45.5% amongst health care workers 33.3% in recipients of multiple blood and blood product transfusion, 25% in sexual partners and their children, 20% in S.T.D. clinic attendants and 10% in patients on haemodialysis.

Bronchogenic carcinoma in young adults.

Clinicopathological features of 26 cases of bronchogenic carcinoma in patients below the age of 40 years have been studied and compared with 271 cases of bronchogenic carcinoma occurring in elderly patients. There was female preponderance (19.23%) in the younger study group compared to the elderly group (6.6%) and increased incidence of smokers in the younger group (57.6% versus 79.3%) and had achieved statistical significance (p < 0.001). Majority (20 out of 26) had a rural background. All the patients were symptomatic at the time of diagnosis and all the 26 cases except one belonged to advanced stage. The incidence of squamous cell carcinoma was almost same for both the age groups. Eighteen of the 26 cases had received antituberculosis chemotherapy by general practitioners before referral to the specialists. Twenty patients were treated initially by palliative radiotherapy and then by chemotherapy.

Epidemic of Vibrio cholerae 0139 in Calcutta.

As one of large outbreaks of cholera-like illness in the Indian subcontinent, Calcutta and its neighbouring areas experienced an unprecedented epidemic due to a new strain of V. cholerae non-01, designated as V. cholerae 0139 Bengal, since January 1993. This epidemic predominantly affected the adult population of Calcutta as evidenced by the hospitalization of more adults at the Infectious Disease Hospital, Calcutta (IDH), which bore the main brunt of the epidemic in and around Calcutta. During the peak of the epidemic about 180 to 300 diarrhoea patients were admitted daily at the IDH. Of the 807 patients screened, 407 were positive for V. cholerae 0139 and majority (82.8%) of the cases were > 10 yr of age. Severe dehydration was recorded in 85.5 per cent of the cases.

Difficulties in the management of superior vena caval obstruction in young adults.

Case records of 50 patients of superior vena caval obstruction in young adults treated and followed-up at Radiotherapy Department, Medical College Hospitals, Calcutta have been looked into. Twenty-eight out of these 50 patients had disease confined to mediastinum only during presentation. In consideration of the fact that the optimum management of superior vena caval obstruction depends upon a balance between just adequate pretreatment investigation and early institution of treatment, the various difficulties in the management discussed. With the existing infrastructural facilities, the institutional policy for the management of superior vena caval obstruction in young adults whose disease is confined to mediastinum only, during presentation, is described.

Eating epilepsy: a study of twenty cases.

Twenty cases of eating epilepsy have been studied over a period of 5 years (1985-1989). Males outnumbered females (4:1). Heavy meal comprising conventional Indian diet (viz, rice, vegetables, etc), was found to be the most important provocating factor (14 out of 20 cases). The attacks occurred at lunch time in most cases (15). Thirteen cases had generalised seizures. Electro-encephalogram showed focal changes in 10 cases, generalised changes in 6 cases, while 4 cases had normal electro-encephalogram. Computerised tomography scan was normal in all the cases (7) when it was done.

Atypical lymphoid hyperplasia (lymphoid tumour of indeterminate nature) of orbit--a case report.

Atypical lymphoid hyperplasia, a rare variety of orbital tumour occurring in a 60 year old male patient is presented with review of literature with special relation to its diagnostic and prognostic difficulties.