Role of modified Widal test in the diagnosis of enteric fever.

OBJECTIVES: To evaluate the diagnostic specificity of modified Widal for recent infection in comparison with conventional Widal test. METHOD: Modified widal test was simultaneously done along with conventional Widal test in serum samples obtained from 50 bacteriologically positive cases of Salmonella typhi infection as well as 50 healthy individuals. RESULTS: A four-fold difference in the titres was noticed in the 50 sera of the test group and no charge in the titres of the control group. The early rising O antibodies which are predominantly IgM in nature. These are due to recent infection and are inactivated by 2-mercaptoethanol. On the other hand H is a mixture of IgG and IgM hence IgM portion gets inactivated giving rise to fall in titre. By inactivating IgM antibodies in modified Widal test, the agglutination would be brought about only by specific IgG while in the conventional Widal test agglutination is due to specific IgG and IgM. The difference in the titres indicates specific IgM class of antibodies which is the hallmark of recent infection. CONCLUSION: If conventional Widal test and modified Widal test are simultaneously done, one can be definite about the diagnosis of enteric fever.

Mixed infection due to leptospira and dengue in a patient with pyrexia.

A case of mixed infection due to Leptospira and Dengue in a two and a half-year-old girl with pyrexia is reported. Early detection and institution of appropriate therapy is crucial and lifesaving.

Clostridium ramosum in a case of cerebellar abscess.

A case of cerebellar abscess due to Clostridium ramosum is reported here. The microbiological workup has been discussed.

Seroprevalence of human immunodeficiency virus infection in an infectious disease hospital.

AIMS AND OBJECTIVES: To analyse clinicopathological features of HIV infected patients admitted in an infectious disease hospital in Mumbai. MATERIAL AND METHODS: Retrospective study of 501 patients admitted from 1st September, 1996 to 28th February, 1998 and screened for HIV status out of clinical suspicion was carried out. HIV seropositivity was established by double confirmation of spot test results with microwell Elisa test. RESULTS: HIV seropositivity was seen in 39.92%. Out of these 94% were adults with male preponderance and 96.5% had only HIV-1 infection. The significant clinical features in HIV positive patients were chronic diarrhea (51.5%), prolonged fever (41.5%) and history of exposure (34%). Pulmonary tuberculosis could be diagnosed in 19.5% of HIV positive patients. In patients with prolonged/recurrent jaundice HBsAg and HIV was noted as a coinfection within 10/42 cases tested. CONCLUSIONS: Increasing prevalence of HIV seropositivity was noted in patients admitted to an infectious disease hospital. Association of HIV infection with tuberculosis and in icteric cases with HBsAg was significant. The HIV screening should be carried out in patients with prolonged illness resistant to usual mode of treatment.

Human immunodeficiency viruses types 1 and 2 infection among replacement blood donors in Mumbai (Bombay).

Between 1993-96, blood donated by 12,235 replacement blood donors was screened by various Enzyme Linked Immunosorbent Assays for detecting antibodies to Human Immunodeficiency Viruses types 1 and 2 according to the guidelines specified by Indian--Food and Drug Administration. 222 replacement blood donors (1.81%) were found to be seropositive for antibodies to Human Immunodeficiency Virus types 1 and 2. Furthermore, the ImmunoComb II HIV 1 & 2 BiSpot rapid sandwich ELISA in a comb format was used for differentially identifying HIV-1 and/or HIV-2 infection among these blood donors in Mumbai. Our data indicates that there is a low seroprevalence of HIV-1-2 infection among replacement blood donors in Mumbai (Bombay). Among them, while HIV-1 is still the predominant virus, dual HIV-1-2 and HIV-2 only infections are steadily increasing.

High frequency of bacteremia with endoscopic treatment of esophageal varices in advanced cirrhosis.

OBJECTIVES: The fregency of bacteremia after endoscopic variceal band ligation (EVL) is reported to be lower when compared to that after endoscopic variceal sclerotherapy (EVS). However, there are conflicting reports on the infectious sequelae after EVL. AIM: To compare the frequency on bacteremia and infectious sequelae after EVL and EVS in patients with cirrhosis of liver. METHODS: Bacteremia and infectious sequelae were studied in 32 sessions of EVL in 18 cirrhotic patients (Child-Pugh class A-6, B-5, C-7), 30 sessions of EVS in 22 cirrhotic patients (Child-Pugh class A-2, B-5, C-15) and 14 diagnostic upper gastrointestinal endoscopies. Blood cultures were collected before, during and 30 minutes after the procedure. Patients were observed for infectious sequelae during subsequent hospitalization. RESULTS: Before the procedure, bacteremia was present in 7/62 (11%) sessions. Significant bacteremia during and 30 min post-procedure developed in 8/32 (25%) and 12/30 (40%) of EVL and EVS sessions, respectively (p = ns), and in 1/14 (7%) upper gastrointestinal endoscopy sessions. There was more frequent bacteremia with severe liver disease (Child-Pugh class A-0/6, B-1/5. C-7/21; p = 0.09) in the EVL but not in the EVS group (Child-Pugh class A-1/3, B-2/5, C-9/22; p = ns). The incidence was higher with emergency sclerotherapy compared to elective sclerotherapy (6/8 [75%] vs 6/22 [27%]; p <0.01). One patient in the EVS group developed spontaneous bacterial peritonitis. CONCLUSIONS: Bacteremia occurs frequently following EVL and EVS in patients with advanced liver diseases. In the EVS group it is more common after emergency sclerotherapy. This bacteremia is rarely associated with significant infectious sequelae.

Seroprevalence of IgG antibodies to Helicobacter pylori among gastrointestinal endoscopists, radiologists and paramedical personnel.

BACKGROUND: The route of transmission of Helicobacter pylori is unknown. Since the organism has been isolated from saliva, gastric juice and stool, medical personnel could be at high risk for acquiring the infection during procedures like gastrointestinal endoscopy. AIMS: To study whether endoscopy is a professional hazard for acquisition of H. pylori. METHODS: We studied the prevalence of IgG antibodies to H. pylori in endoscopists (n = 17), radiologists (n = 17) and personnel from paraclinical branches (n = 35); microbiology (n = 21), pathology (n = 7) and forensic medicine (n = 7); among the paraclinical personnel five were at high risk because they worked with cultures of H. pylori. Subjects answered a questionnaire regarding upper gastrointestinal symptoms, and precautions taken at the work place against infection. The serum was tested for IgG antibodies to H. pylori using a microwell ELISA and a rapid card test. RESULTS: H. pylori antibodies were present in five (29.4%) endoscopists, three (17.6%) radiologists and seven (20%) paraclinical personnel; only one of the 5 high risk para medical personnel was positive. There was no correlation between the duration of performing endoscopies and the H. pylori IgG status. CONCLUSION: Endoscopy is not a risk factor for acquiring H. pylori infection.

Antibiotics sensitivity pattern of N. gonorrhoeae with special emphasis on norfloxacin and ciprofloxacin.

The current study is carried out to find the in-vitro susceptibility of N. gonorrhoeae to Ciprofloxacin, Norfloxacin, Gentamycin etc. in 110 isolates obtained from acute gonococcal urethritis confirmed by smear examination. The isolates obtained are from the patients attending the Skin and STD Clinic of a teaching hospital, clinically diagnosed as suffering from acute gonococcal urethritis. Antibiotic susceptibility test was done by Kirby Bauer disc diffusion technique. Four to five similar well isolated colonies of the gonococcal strains were picked up with a wire loop and transferred to 5 cc of sterile trypticase soya broth (TSB). Tubes were incubated at 36 degrees C. GC agar base plates were inoculated with suspensions using a sterile cotton swab. Antibiotic discs were placed on these plates. The plates were incubated at 35 degrees C for 18-24 hours in a candle jar with 5-10% CO2. The plates were then observed to note the zones of inhibition around the discs. 87.27% of isolated strains were inhibited by norfloxacin at an MIC of 0.06 mu gm/ml; 89.08% of the strains were inhibited by ciprofloxacin at an MIC of 0.025 mu gm/ml. All the strains (110) were inhibited by ciprofloxacin at a concentration of 0.2 mu gm/ml. Gentamycin sensitivity was 86.36%. Out of 110 patients, 85 were treated with norfloxacin of which 81 (95.29%) were cured. Twenty five were treated with ciprofloxacin of which 24 (96%) were cured. This study shows high sensitivity of N. gonorrhoeae to norfloxacin and ciprofloxacin.

Humoral and cell mediated immune responses in patient with tuberculous meningitis.

A study was carried out to find out the humoral and cell mediated immunity levels in patients with TBM and healthy controls. For humoral immunity, the amounts of immunoglobulins--IgG, IgM and IgA were quantitated by SRID method. For cell mediated immunity, percentages of total T cells, Th cells and Ts cells and the ratio of Th:Ts cells was studied. Hypergammaglobulinemia of all three immunoglobulins was observed together with a decrease in the total T cells and Th cells, and a lower Th:Ts cell ratio indicating a deficiency or a defect in the immune system of patients infected with TBM.

Detection of antibodies to HIV in saliva.

BACKGROUND: Saliva has been recommended as an alternative non-invasive specimen for detection of antibodies to human immunodeficiency virus (HIV) because of the inherent disadvantages of using serum for such testing. METHODS: In a double-blind study, paired serum and saliva specimens were collected from 100 known HIV antibody seropositive and 100 seronegative individuals. The serum was tested in the conventional way while saliva was tested after modifying the routinely used serum enzyme-linked immunosorbent assay so as to detect antibodies to HIV from saliva. RESULTS: The sensitivity of saliva for HIV antibody detection using the modified test protocol was found to be 95% by GENELAVIA MIXT ELISA and 97% by DETECT-HIV ELISA, while the specificity for both was 100%. Identical results were obtained even after 7 months of storage of the saliva at 4 degrees C without any preservatives. CONCLUSION: Saliva is a safe and cost-effective alternative to serum for HIV antibody detection for most surveillance purposes but not for diagnostic purposes.

Increasing prevalence of HIV-2 and dual HIV-1-2 infections among patients attending various outdoor patient departments in Mumbai (Bombay).

Between 1993-96, a serological study was carried out for differentially identifying HIV-1 and HIV-2 infections among the high risk group persons attending the various outdoor patient departments of BYL Nair Municipal Hospital, Mumbai. This study indicates that although HIV-1 is still the predominant virus among the high risk HIV infected persons in Mumbai, dual HIV-1-2 infections are increasing especially among promiscuous heterosexuals and female commercial sex workers. Increases in HIV-2 infections were observed later than dual HIV-1-2 infections, indicating that it is the HIV-1 infected individuals who through continued high risk behavior got infected by HIV-2.

Cellular and humoral factors in colostrum of HIV infected and uninfected lactating mothers.

OBJECTIVE: To compare the cellular and humoral factors in colostrum from HIV infected and uninfected lactating mothers. DESIGN: Cross sectional study. SETTING: Maternity Ward. METHODS: Colostrum was collected from 130 mothers (62 HIV seropositives and 68 HIV seronegatives). These colostrum samples were tested for total cell count, cell viability, differential count, phagocytic activity of macrophages, 'T' cell counts, IgA, IgM and IgG levels. RESULTS: There was a statistically significant decrease in the phagocytosis and 'T' cell number (p <0.001) and in the IgA and IgG levels (p<0. 05) in the colostrum obtained from HIV seropositive mothers as compared to HIV seronegative ones. CONCLUSION: Some of the cellular and humoral factors are reduced in colostrum samples obtained from HIV seropositives as compared to normals.

A study of mycotic keratitis in Mumbai.

A total of 1010 clinically suspected cases of mycotic keratitis were studied from 1988 to 1996 for evidence of fungal infection and for identification of the aetiologic agents of keratitis in Mumbai. Of these 367 cases were reported positive by microscopy and culture. Seventy nine percent of the cases were between the ages 21 and 50 years. Male patients were more often affected than females. Eighty eight percent of patients were farmers or construction workers and 89.92% of cases gave a definite history of antecedent corneal trauma. A single fungal isolate was obtained in 307 cases and multiple isolates in 20 cases. Mixed isolates of bacteria and fungi were grown in 40 cases. The predominant isolate was Aspergillus species in 219 cases, followed by Candida species (36), Fusarium species (33) and Penicillium species (34). Filamentous fungal isolates from 22 cases remained unidentified. Mycotic keratitis should be suspected in every patient with a corneal lesion and should be ruled out before commencing steroids and antiboitics.

Increasing prevalence of dual HIV-1-2 infections among voluntary blood donors in Mumbai (Bombay).

Between 1993 and 1996, we carried out a serological screening for differentially identifying HIV-1 and HIV-2 infections among the high risk group persons admitted in the various wards of BYL Nair Hospital, Mumbai, using the ImmunoComb kit. This study indicates that although HIV-1 is the predominant virus prevalent in Mumbai, dual HIV-1-2 and HIV-2 infections are gradually increasing.

Increasing prevalence of HIV-2 and dual HIV-1-2 infections among high risk group hospital admitted patients in Mumbai (Bombay).

Between 1993 and 1996, we carried out a serological screening for differentially identifying HIV-1 and HIV-2 infections among the high risk group persons admitted in the various wards of BYL Nair Hospital, Mumbai, using the ImmunoComb kit. This study indicates that although HIV-1 is the predominant virus prevalent in Mumbai, dual HIV-1-2 and HIV-2 infections are gradually increasing.

Effect of honey on multidrug resistant organisms and its synergistic action with three common antibiotics.

A total of 15 bacterial strains (7 Pseudomonas & 8 Klebsiella species) isolated from various samples which showed multi-drug resistance were studied to verify in vitro antibacterial action of honey on the principle of Minimum Inhibitory Concentration (MIC) & its synergism with 3 common antibiotics--Gentamicin, Amikacin & Ceftazidime. The MIC of honey with saline for both organisms was found to be 1:2. The synergistic action was seen in the case of Pseudomonas spp. and not with Klebsiella spp.

Dental plaque: an unlikely reservoir of Helicobacter pylori.

BACKGROUND AND AIM: Dental plaque has been suggested as a reservoir for Helicobacter pylori, though data in this regard are conflicting. We evaluated the prevalence of H. pylori DNA in dental plaque using polymerase chain reaction (PCR). METHODS: Antral H. pylori status of 156 patients with acid-peptic disease (APD) was studied by rapid urease test (RUT), histology and culture. Dental plaque obtained from these 156 patients and 92 healthy volunteers was evaluated for the presence of H. pylori using RUT, culture and PCR. RESULTS: H. pylori was present in 133 antral biopsy samples by RUT and/or histology. The dental plaque of 37 patients with APD and 21 healthy volunteers tested positive by RUT. H. pylori was not isolated by culture from any of the dental plaques. PCR gave a significant amplification product in 11 of 248 (4.4%) dental plaque samples, 7 from patients with APD and 4 from normal healthy volunteers. CONCLUSION: The frequency of H. pylori in the dental plaque is low, and this is unlikely to be a prominent site of infection with H. pylori.

Seroprevalence of hepatitis A virus in Mumbai, and immunogenicity and safety of hepatitis A vaccine.

OBJECTIVES: Since epidemiologic trends of hepatitis A are changing worldwide, we studied its seroprevalence in Mumbai, which is thought to be a high-endemicity area. The immunogenicity and safety of a hepatitis A vaccine were also studied. METHODS: Six hundred and seventy subjects (456 men; age range 6 mo-60 y) answered a questionnaire on social and medical history. Qualitative analysis of total anti-HAV was performed in all subjects by ELISA. One hundred and seven of 147 anti-HAV negative subjects received hepatitis A vaccine at months 0, 1 and 6. Subjects were followed up (months 1, 2, 6, 7) to look for side-effects and seroconversion. RESULTS: The seroprevalence of HAV was 523/670 (78%); 38% of children < 5 years were anti-HAV negative. Seroprevalence rates of 80% were reached by 15 years. Prevalence was lower in the higher socio-economic group (151/234; 64.5%) compared with the lower socio-economic group (372/436; 85%) (p < 0.001). One month after doses 1, 2 and 3 of the hepatitis A vaccine, seropositivity was 92%, 99% and 100%, respectively. Minor self-limited side-effects occurred in 19.5% of subjects; there were no major side-effects. CONCLUSIONS: The seroprevalence of anti-HAV is high in Mumbai. Seroprevalence is lower in the higher socio-economic groups. The hepatitis A vaccine is safe and immunogenic.