Hospital-based Surveillance of Invasive Pneumococcal Disease and Pneumonia in South Bangalore, India.

Objective: To estimate the incidence of invasive pneumococcal disease and pneumonia, distribution of pneumococcal serotypes, and antibiotic susceptibility in children aged 28 days to <60 months. Design: Hospital-based surveillance. Setting:; South Bangalore, India. Participants: 9950 children aged 28 days to <60 months with clinical suspicion of invasive pneumococcal disease or pneumonia. Results: The estimated at-risk population included 224,966 children <5 years of age. Forty cases of invasive pneumococcal disease were identified. Estimated invasive pneumococcal disease incidence was 17.8/100,000 with incidence being highest among children aged 6 months to <12 months (49.9/100,000). Clinical pneumonia syndrome was the most frequent diagnosis (12.5/100,000). Pneumococcal serotypes included: 6A (n=6, 16.7%); 14 (n=5, 13.9%); 5 (n=4, 11.1%); 6B (n=4, 11.1%); 1, 18C, and 19A (n=3 each, 8.3%); 9V (n=2, 5.6%); and 3, 4, 10C, 18A, 18F, and 19F (n=1 each, 2.8%). Serotypes 6A, 14, 6B, 1, 18C, 19A, 9V, 4, 10C, and 18A showed antibiotic resistance. Clinical pneumonia incidence was 2109/100,000, with incidence being highest among children aged 28 days to <6 months (5033/ 100,000). Chest radiograph-confirmed pneumonia incidence was 1114/100,000, with incidence being highest among children aged 28 days to <6 months (2413/100,000). Conclusion: Invasive pneumococcal disease and pneumonia were found to be common causes of morbidity in young children living in South Bangalore, India.

In vitro antibacterial activities of Broccoli (Brassica oleracea L.var italica) against food borne bacteria.

Foodborne diseases remain substantial and safety of food is an important health, social and economical issue. Food borne illnesses caused by microbial contamination raises concerns to find alternate sources which are safe to human and environmental health. This study was investigated to determine the antibacterial activity of broccoli (Brassica oleracea L. var. italica). Various solvent extracts of broccoli were prepared and analyzed for their phytoconstituents. A total of six food borne bacteria viz., Bacillus cereus ATCC 10876, Bacillus subtilis ATCC 6633, Staphylococcus aureus ATCC 6538, Escherichia coli ATCC 8739, Salmonella typhimurium MTCC 3224 and Shigella flexneri ATCC 12022 were tested against the broccoli extracts. Minimum inhibitory concentration (MIC) values of 10 - 320 μg ml-1 were recorded against most of the pathogens with acetone and methanol as the potential extracts. B. subtilis ATCC 6633 (15.4 mm) and Bacillus cereus ATCC 10876 (16.3 mm) were found to be the most sensitive organisms among the pathogens tested.

Profile of Hemophagocytic Lymphohistiocytosis in Children in a Tertiary Care Hospital in India.

Objective: To describe the epidemiology, clinical features, laboratory findings, outcome and the difficulties in diagnosis and management of children with Hemophagocytic Lymphohistiocytosis (HLH) in a tertiary children’s hospital in India. Study Design: Retrospective analysis of case records of all the children with a diagnosis of HLH from December 2006 to December 2008. Setting: Tertiary care children’s teaching hospital in Chennai, India. Results: 43 children had a diagnosis of hemophagocytosis, of who only 33 (19 male, mean age 46 months, range 50 days-14 years) met the inclusion criteria based on the HLH-2004 protocol of the Histiocyte Society. The predominant presenting features included prolonged fever and hepatosplenomegaly. CNS symptoms were present in 36%. Anemia (Hb <9gm/dL), and thrombocytopenia (platelets <1,00,000/mm3) were present in 97% and 72%, respectively. Among the biochemical markers, hyperferritinemia was present in 97%, and hypofibrinogenemia and high LDH in 92%. Bone marrow examination showed hemophagocytosis in 84%. Infectious agents were identified in 42% children, with viruses accounting for 2/3 of them (5 Dengue virus, 3 EBV, 1 CMV, 1 TB and 5 bacterial agents). The mean duration between the onset of symptoms and the diagnosis was 16 days. Corticosteroids were the most commonly used immunomodulatory agents (67%), followed by IVIg (64%). Cyclosporine was used in 33% and Etoposide in 15%. Improvement of laboratory parameters was noticed within 5-7 days of starting treatment. Overall survival rate was 76%. Conclusion: HLH should be considered in the differential diagnosis of children with prolonged fever, hepatosplenomegaly and cytopenia. Prompt recognition and appropriate therapy may result in good outcome, particularly in Infection associated HLH.

Review of virulence factors of enterococcus : An emerging nosocomial pathogen.

Enterococcus, considered a normal commensal of intestinal tract, is fast emerging as a pathogen causing serious and life threatening hospital borne infections. This is attributed to acquisition of multi drug resistance and virulence factors of the organisms. The sequencing of Enterococcus faecalis has given a lot of insight into its genetic makeup. The E. faecalis strain V583, which has been sequenced, contains a total of 3182 open reading frames (ORFs) with 1760 of these showing similarity to known proteins and 221 of unknown functions. Strikingly unique to this genome is the fact that over 25% of the genome is made up of mobile and exogenously acquired DNA which includes a number of conjugative and composite transposons, a pathogenicity island, integrated plasmid genes and phage regions, and a high number of insertion sequence (IS) elements. This review addresses the genomic arrangement and the study of virulence factors that have occurred since the sequencing of the genome.

An epidemiological study of animal bites in India: results of a WHO sponsored national multi-centric rabies survey.

This was a WHO sponsored national multi-centric rabies survey and one of its objectives was to find out the incidence of animal bites, anti-rabies treatment practices, Pet dog population and their care. Twenty-one medical colleges chosen with geoscatter representation conducted the survey during February-August, 2003. The survey was conducted in 18 states, covering a population of 52,731 chosen randomly from 8500 households. The annual incidence of animal bites was high, 1.7% and it was more in rural areas (1.8%), children (2.6%) and poor/low income group (75%). The main biting animal was dog (91.5%), mostly stray (63%), followed by cat (4.7%). A high proportion of bite victims did not wash their wounds with soap and water (39.5%), preferred Government hospitals (59.9%) and nerve tissue vaccine (46.9%). The use of rabies immunoglobulin was low (2.1%). A single animal bite episode led to a loss of 2.2 man-days and the cost of medicines including anti-rabies vaccine was Rs.252 (US$6). The recourse to indigenous treatment (45.3%) and local application to wound (36.8%/) was quite prevalent. About 17% of households reported having a pet/domesticated dog and the pet dog: man ratio was 1: 36. Pet dog care/management practices were not satisfactory with a low veterinary consultation (35.5%) and vaccination (32.9%). The situation was slightly better in urban areas. The people also reported the presence (83%) and menace (22.8%) of stray dogs. It is recommended to initiate appropriate community awareness and dog vaccination campaigns and effective stray dog control measures.

A cross-sectional seroprevalence survey for HIV-1 and high risk sexual behaviour of seropositives in a prison in India.

This study was conducted to know whether prisoners constitute a "high risk group" for HIV transmission in India today. A sero-epidemiological period prevalence survey was conducted in Central Prison, Bangalore, South India covering 1007 undertrials and 107 permanent convicts during January to December 1993. Twenty (1.98%) undertrials and none of the permanent convicts were seropositive for HIV infection. All of them were males and 1.6(80%) of them were in the age group of 20-30 years. Low literacy, poor income, sexual promiscuity and low condom usage were observed among the seropositives. Thus, prisoners constitute a high risk group and routine screening and counselling are recommended.

Littre's hernia in a child--an operative surprise (a case report).

The incidence of Littre's hernia in children is unknown. The diagnosis is usually made at operation or autopsy. One case in an eight month old infant is described. Heterotropic mucoglandular tissue causing nodularity and adhesions was noted in the diverticulum. Though histological findings in Littre's hernia are not mentioned in previous reports, we believe that Littre's hernia could often be associated heterotropic mucosa.