The spectrum of perforation peritonitis - central India experience.

Introduction: Peritonitis secondary to gut perforation is one of the most common surgical emergencies in India and is associated with high morbidity and mortality. The aim of this study was to recognize the spectrum of perforation peritonitis as managed at Govt. Chhattisgarh Institute of Medical Sciences hospital Bilaspur Chhattisgarh, in central India. Method: A retrospective analysis of 618 patients was done,in terms of clinical presentation, duration, seasonal variation, operative findings and post operative morbidity and mortality, admitted at Chhattisgarh Institute of Medical Sciences hospital Bilaspur. Chhattisgarh, over a period of 03 years. All the patients had undergone emergency laprotomy and the site of perforation was identified. Results: The most common site of perforation was prepyloric (393 cases. 63.6%).In 22.16% of the cases the perforation was associated with typhoid fever and in 2.7% cases with abdominal Koch’s. Trauma however showed perforation in only 5.6% cases, mainly jejunal. The overall mortality was 12.13%. Conclusion: Non traumatic upper gastrointestinal perforation peritonitis is common in our place. In contrast to the west, where lower gastrointestinal tract perforations predominate, in India upper gastrointestinal tract perforations constitute the majority of cases.

Staphylococcus aureus colonization of anterior nares of school going children.

Objective. To determine the colonization rates of S. aureus in anterior nares of school going children, evaluate the antimicrobial resistance of such isolates against various antibiotics. Methods. Nasal swabs taken for S.aureus in 392 healthy school going children aged between 5 and 15 yr belonging to three schools surrounding Kamineni Institute of Medical Sciences, Narketpally, Andhra Pradesh, India. Swabs were inoculated in to Mannitol Salt Agar (MSA) and incubated at 37o C for 24hr, Staphylococcus aureus isolates were identified by standard microbiological methods such as Gram’s stain, catalase and coagulase. MICs were determined by Agar dilution technique against Vancomycin, Ciprofloxacin, Sparfloxacin, Sparfloxacin ß Cyclodextrin. Antimicrobial resistance patterns of all the isolates against Oxacillin (1 μg) Penicillin (10units), Ampicillin (10μg), Co-trimoxazole (23.75 μg), Erythromycin (15 μg), Tetracycline (30 μg) and Gentamicin (10 μg) were tested using Kirby-Bauer disk diffusion method in accordance with CLSI standards. Results. Of the 392 samples screened 63(16%) showed the growth of Staphylococcus aureus. Twelve (19%) isolates were found to be MRSA. Antimicrobial susceptibility testing using Agar dilution method against Vancomycin, ciprofloxacin , Sparfloxacin, and Sparfloxacin β Cyclodextrin revealed MICs in the range of 0.52 μg/ml, 0.51 μg/ml, 0.5 μg/ml and <0.0312- 0.250 μg/ml respectively. Disk diffusion method showed that all the isolates were resistant to Penicillin and Ampicillin. A resistance of 14.3%, 25% and 22.2% was observed against Co-trimoxazole, Erythromycin and Tetracycline respectively. Gentamiicin was the only antibiotic against which most of the isolates were sensitive. Conclusion. Our results suggest that healthy school going children under 16 yr of age are potential carriers of S. aureus and in particular MRSA and multi-drug resistant strains.

Enterobacter cloacae: A predominant pathogen in neonatal septicaemia.

A total of 120 blood samples from neonates presenting with clinical signs of septicaemia were subjected for culture using brain heart infusion agar biphasic medium (BHI BPM) and glucose broth. Bacterial agents were isolated from 48 numbers (40%) of cultures. Gram-negative bacilli were isolated in maximum percentage (88.45%) of cases whereas gram-positive bacteria (coagulase negative staphylococci and group B streptococci) in 11.6% of cultures. E.cloacae (39.5%) was maximally isolated among the pathogenic bacteria followed by K.pneumoniae (23.2%), E.coli (11.6%) and others like Acinetobacter spp. (6.9%), Citrobacter freundi (4.6%) and P.mirabillis (2.3%). All the gram-negative bacilli isolates showed 100% susceptibility to amikacin, whereas 85% of E.cloacae isolates were sensitive to the same. Thus E.cloacae was found to be a predominant moderately sensitive pathogen in neonatal septicemia.

Epidemic of Vibrio cholerae serogroup O139 in Berhampur, Orissa.

During the months of May-June 2000, 194 patients with watery diarrhoea were admitted to the Infectious Diseases Ward of the M.K.C.G. Medical College, Berhampur. Ninety four rectal swabs were collected and processed according to the standard procedures. Vibrio cholerae strains were isolated from 20 samples. Of these 20 isolates, two were found to be V. cholerae O1 EITor Ogawa strain and 18 were confirmed to be V. cholerae serotype O139. All V. cholerae O139 isolates were of a single phage type (phage type 1) and the two O1 strains were of phage type 3 and phage type 27 respectively. All 20 V. cholerae isolates were positive for CAMP test, and showed uniform resistance to furazolidone and sensitivity to co-trimoxazole, amoxycillin, norfloxacin, tetracycline and gentamycin. V. cholerae O139 serotype has not been reported earlier in south Orissa. This is probably the first report of its isolation from this area.

Monoclonal antibody based dot-enzyme linked immunosorbent assay (Dot-ELISA) and agar gel precipitation test (AGPT) for identification of Newcastle disease virus (NDV).

Two mouse monoclonal antibodies (MAbs), viz. 2B7 and 2 D10 raised against haemagglutinin-neuraminidase glycoprotein of Newcastle disease virus (NDV) were used to identify several other field isolates and vaccine strains of NDV. These MAbs reacted specifically with all the NDV strains/isolates in Dot-ELISA whereas, only MAb 2D10 reacted with all the NDV strains/isolates in agar gel precipitation test. These two tests employing the MAbs were standardised for rapid diagnosis and identification of NDV.