A case of extended spectrum beta-lactamase producing Salmonella enterica serotype paratyphi A from India.

Enteric fever caused by Salmonella enterica is a systemic infection with high rates of morbidity and mortality. Increasing antibiotic resistance in S. enterica has led to shift in the choice of antibiotics used against this organism from chloramphenicol and ampicillin to trimethoprim-sulfamethoxazole, fl uoroquinolones, and extendedspectrum cephalosporins. Resistance to cephalosporins, due to the production of extended-spectrum beta-lactamases (ESBLs), is the cause of serious concern worldwide. So far, these enzymes have been detected in many species of the family Enterobacteriaceae including different serotypes of S. enterica. To the best of our knowledge, however, ESBL production in Salmonella Paratyphi A has not yet been reported from India. We present here a case of ESBL producing Salmonella Paratyphi A from India. This is a worrisome fi nding with grave clinical implications, since the dissemination of this resistance trait would further limit the therapeutic options available for the treatment of enteric fever.

Subacute Sclerosing Panencephalitis in a Tertiary Care Centre in Post Measles Vaccination Era.

This study was conducted to observe the impact of measles vaccination on the epidemiology of subacute sclerosing panencephalitis (SSPE) in the post measles vaccination era. This is a retrospective study from a tertiary care hospital, covering a ten year period starting a decade after the introduction of the national measles immunization programme in India. We analyzed 458 serologically confirmed SSPE cases. These patients had a high cerebrospinal fluid: serum anti-measles antibody ratio. The male to female ratio in the present study was 4.4:1. The mean age at onset of SSPE was 13.3 years, showing an increase in mean age at onset of SSPE. Clinical and other demographic details, available from 72 in-patients, are discussed in this report. Of these, a history of measles could be elicited in 34 cases. Mean latent period between measles infection and onset of SSPE was 7.8 years. Six patients gave a history of measles vaccination. A sizable percentage (15.5 %) of the patients was ≥ 18 years old and considered to have adult onset SSPE. The incidence of SSPE continues to be high and this report highlights the need for further strengthening routine measles immunization coverage.

Efficacy of repeat sputum examination in RNTCP.

BACKGROUND: The guidelines of repeat sputum smear examination in initial smear negative patients (ISN), who also fail the antibiotic trial of three samples have been incorporated in the RNTCP diagnostic algorithm in India in 2005. This study was conducted to assess the utility of repeat sputum smear examination in symptomatic initial smear negative patients to detect new smear positives in the state of Delhi. MATERIAL AND METHODS: The monthly records of the laboratory abstracts for the six quarters for all the 24 districts of Delhi were analysed w.e.f. first of January 2006 to 30th June 2007. RESULTS: A total of 243,244 TB suspects were examined for diagnosis during the six quarters w.e.f. January 2006. Of these, 37,666 were found positive on sputum smear microscopy giving a positivity rate of 15.4%. During the same period, a total of 2,195 (1% of ISN ) TB suspects underwent repeat sputum examination, of which 272 were found positive giving a mean positivity of 12.3%. CONCLUSION: A significant number of apparently smear negative TB cases may in fact be smear positive due to various reasons and can be detected by a simple repeat sputum examination. Yield of sputum positive cases in sputum reexamination is almost the same as in initial sputum examination i.e. 10-15%. Therefore, the policy of repeat sputum examination in symptomatic initial sputum negative cases failing the antibiotic trial should be meticulously followed as advocated in the RNTCP diagnostic algorithm.

Refractory isosporiasis.

The authors describe a case of severe debilitating diarrhea due to isosporiasis in a two year old child, a known case of systemic vasculitis receiving prolonged corticosteroids therapy, an association rarely reported previously. It was refractory to treatment with dihydrofolate reductase inhibitor combined with sulfonamide such as cotrimoxazole to which isosporiasis usually responds well and is being described here for clinical interest and uniqueness of its presentation and laboratory findings.

Plasmodium lactate dehydrogenase assay to detect malarial parasites.

BACKGROUND: Microscopic examination of blood smears remains the gold standard for the diagnosis of malaria. However, it is labour-intensive and requires skilled operators. Immunochromatographic dipstick assays provide a potential alternative. One such dipstick, the Plasmodium lactate dehydrogenase assay (pLDH), is based on detection of the Plasmodium intracellular metabolic enzyme, LDH. The differentiation of malarial parasites is based on the antigenic differences between the pLDH isoforms. This study was designed to assess the sensitivity and specificity of pLDH assays in detecting and differentiating between various malarial species compared with microscopy. METHODS: Blood samples (n = 124) submitted to our laboratory for routine diagnosis of malaria were included in this study. From each blood sample, two thin films and a quantitative buffy coat (QBC) were made for microscopy. Thin films were stained with Giemsa and acridine orange. The pLDH assay was performed on all the samples according to the manufacturer's instructions. RESULTS: Of the 124 blood samples, 84 were negative by all methods (Giemsa, acridine orange, QBC and pLDH assay). Of the 38 samples positive for Plasmodium falciparum on microscopy, pLDH assay correctly identified 36 at parasite counts as low as < 40 parasites/microl and had a sensitivity and specificity of 94.3% and 97.6%, respectively. Of the 21 samples positive for Plasmodium vivax, pLDH assay correctly identified 19 at parasite counts as low as < 80/microl, and had a sensitivity and specificity of 90.4% and 100%, respectively. However, it failed to identify two Plasmodium vivax infections at parasite counts of 5000/microl and > 200/microl, suggesting that plasmodial gene deletions could be responsible for non-expression of pLDH. CONCLUSIONS: Our data demonstrate that pLDH assay, given its accuracy, rapidity (10-15 minutes), ease of performance and interpretation, can be a useful tool for the detection of malaria in countries where both plasmodial species are co-endemic and where laboratory support is limited.