Cryptococcal Antigenemia in HIV-Infected Patients with CD4+ T-cell Count ≤ 200 cells/μl: A study from a tertiary care hospital

Introduction: Cryptococcal meningitis is one of the leadingopportunistic infections associated with high mortality. Thepresent study was carried out to determine the prevalence ofcryptococcal antigenemia in HIV-infected patients with CD4+T-cell count ≤ 200 cells/μl.Material and methods: A cross-sectional study includinga total of 100 blood samples of HIV-infected patients withCD4+ T-cell count ≤ 200 cells/μl was carried out in a tertiarycare hospital. The Cryptococcal Antigen Latex AgglutinationTest was performed on serum separated from blood samplesincluded in the study group. A positive cryptococcalantigenemia was diagnosed by positive latex agglutinationtest of cryptococcal polysaccharide antigen in serum. BMI ofall patients included in the study group was calculated andWHO clinical staging of all patients was noted.Results: Three cases out of 100 were positive for cryptococcalantigenemia. The positive cases showed correlation with lowBMI and WHO Clinical stage II and III of HIV disease. Inthe present study, 33.33% and 66.67% of positive cases hadCD4+ T-cell count within the range of 0-100cells/μl and101-200cells/μl respectively.Conclusion: It is important to implement routine screeningfor cryptococcal antigen among HIV-infected cases withCD4+ T-cell count ≤ 200 cells/μl for early detection ofcryptococcal antigenemia. It will help in identifying the riskof subsequent cryptococcal meningitis and initiation of preemptive antifungal treatment.

Methicillin resistant Staphylococcus aureus (MRSA) in India Prevalence & susceptibility pattern.

Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA) is endemic in India and is a dangerous pathogen for hospital acquired infections. This study was conducted in 15 Indian tertiary care centres during a two year period from January 2008 to December 2009 to determine the prevalence of MRSA and susceptibility pattern of S. aureus isolates in India. Methods: All S. aureus isolates obtained during the study period in the participating centres were included in the study. Each centre compiled their data in a predefined template which included data of the antimicrobial susceptibility pattern, location of the patient and specimen type. The data in the submitted templates were collated and analysed. Results: A total of 26310 isolates were included in the study. The overall prevalence of methicillin resistance during the study period was 41 per cent. Isolation rates for MRSA from outpatients, ward inpatients and ICU were 28, 42 and 43 per cent, respectively in 2008 and 27, 49 and 47 per cent, respectively in 2009. The majority of S. aureus isolates was obtained from patients with skin and soft tissue infections followed by those suffering from blood stream infections and respiratory infections. Susceptibility to ciprofloxacin was low in both MSSA (53%) and MRSA (21%). MSSA isolates showed a higher susceptibility to gentamicin, co-trimoxazole, erythromycin and clindamycin as compared to MRSA isolates. No isolate was found resistant to vancomycin or linezolid. Interpretation & conclusions: The study showed a high level of MRSA in our country. There is a need to study epidemiology of such infections. Robust antimicrobial stewardship and strengthened infection control measures are required to prevent spread and reduce emergence of resistance.

Determination of antibacterial activity of polyenzyme preparations Gumseb using in vitro methods.

A novel polyenzyme formulation Gumseb developed by Advanced Enzyme Technologies Ltd, Thane and Speciality Biochemicals Co., USA, was tested for antibacterial properties using ATCC strains and clinical isolates of Salmonella typhi, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae. A modified antibiotic susceptibility test was used for the purpose. S. aureus, S. pyogenes and S. pneumoniae were found to be sensitive to the formulation at the chosen concentration. Next, to study the interaction between Gumseb and currently used antibiotic, a checkerboard Minimum Inhibitory Concentrations (MIC) was carried out for each organism. The assay was carried out with the aim of establishing whether the polyenzyme formulation had any potentiating effect on the antibiotic of choice. Synergistic effect was established when Gumseb was used in conjunction with penicillin against S. pyogenes. Partial synergy was established when it was used in conduction with Ceftazidime against P. aeruginosa and with Ciprofloxacin against methicillin sensitive, coagulase positive S. aureus. Antagonism was established when it was used in conjunction with Ampicillin against E. coli, with Ciprofloxacin against S. typhi and coagulase negative staphylococcal strain. The results indicate that Gumseb can be used in conjunction with those antibiotics with which a synergistic or a partially synergistic effect could be shown, as in the case of P. aerugionosa and S. aureus. These findings have particular importance since these organisms are responsible for hospital based infections and are notorious for antibiotic resistance. In cases where antagonism was established, it should not be used in combination with that particular antibiotic. However, it can be used individually since it has proved to have antibacterial activity and MIC could be determined for all five commonly encountered pathogens. Therefore, it has the potential of being a novel broad range antibacterial drug. These findings are significant given the alarming rise in incidence of antibiotic resistance in most clinically important pathogens.

Factors associated with drug resistance in pulmonary tuberculosis.

BACKGROUND: Drug-resistant tuberculosis is becoming a formidable foe for the mankind as it is difficult to manage. The present study was aimed at studying the factors associated with drug resistance in tuberculosis. METHODS: One-hundred and nine patients from whom mycobacterial growth was obtained on culture were studied. RESULTS: Treatment default was found to be the most important factor associated with drug resistance. Forty-five of the 48 isolates from patients with history of default showed drug resistance. Travel to a different place was the reason for default in 19 of 45 patients with drug resistance. Symptom relief in 12, cost of treament in two and adverse drug effect in 12 patients were the other commonly observed reasons for default. A history of relapse was also found to be associated with drug resistance. Nineteen of the 34 isolates obtained from these patients showed drug resistance. In contrast, drug resistance was seen in only four of the 27 new, untreated patients with mycobacterial growth. CONCLUSIONS: Drug-resistant tuberculosis is a major problem in the control of tuberculosis. Its resurgence should be controlled by scrupulously monitoring and ensuring patient compliance.

Role of IgM specific indirect immunofluorescence assay in diagnosing an outbreak of leptospirosis.

The study was conducted during a suspected epidemic of leptospirosis in Maharashtra. A total of 13 acute phase blood samples, collected at 5-6 days from the onset of symptoms, and 10 convalescent phase samples, colected at around 20 days from the onset of symptoms were obtained from 13 patients. Sera were separated and the samples were subjected to Microagglutination Test (MAT) and IgM-Indirect Immunofluorescence assay (IFA) to detect antibodies against leptospira. In the acute phase sera, only one sample was positive by MAT while seven were positive by IFA. In the convalescent samples, six were positive by MAT and seven were positive by IFA. IFA is a rapid test and can be used for early diagnosis of leptospirosis.