Alarming resistance of Neisseria gonorrhoeae in a tertiary care hospital of North India

Background: This study attempted to elucidate the spectrum of sexually transmitted infections in a tertiary care centre in North India and to assess the antimicrobial resistance in Neisseria gonorrhoeae. Materials and Methods: Antimicrobial resistance pattern of N. gonorrhoeae was determined by the standard techniques. Genotypic detection of gyrA, parC and blaTEM genes was also carried out. The results of gyrA gene by polymerase chain reaction were confirmed by DNA sequencing. Results: N. gonorrhoea was identified in 10 (4.98%) patients, and antimicrobial sensitivity was performed in seven patients. All the seven patients tested were quinolone-resistant N. gonorrhoeae (QRNG), 5/7 were penicillinase-producing N. gonorrhoeae, 1/7 was chromosomally mediated penicillin-resistant N. gonorrhoeae and 3/7 were tetracycline-resistant N. gonorrhoeae. Minimal inhibitory concentration (MIC) by E-test was performed in five strains, and we observed that MIC90 for ciprofloxacin was ?4 ?g/ml, for penicillin was ?6 ?g/ml and for tetracycline was 12 ?g/ml, which clearly brackets them as resistant isolates. The presence of TEM gene was confirmed genotypically in six out of seven cases. In all seven cases, gyrA and parC were observed, thus confirming their QRNG status. Conclusion: Alarming increase in the resistance to commonly used antimicrobials for gonorrhoea in our study, especially of fluoroquinolones, is a clarion call for the urgent need for prudence in prescribing them. Observing the rampant resistance exhibited by N. gonorrhoeae, it is clear that the day is not far when it will acquire a superbug status and become intractable to treatment by the available antibiotics.

Prevalence of scrub typhus in pyrexia of unknown origin and assessment of interleukin-8, tumor necrosis factor-alpha, and interferon-gamma levels in scrub typhus-positive patients

Background: Scrub typhus is lesser known cause of fever of unknown origin in India. Even if there have been reports documenting the prevalence of scrub typhus in different parts of India, it is still an unknown entity, and clinicians usually do not consider it as differential diagnosis. The present study was performed to document the prevalence of scrub typhus among febrile patients in western part of Uttar Pradesh and to assess the clinical profile of infected patients on the one hand and knowledge, attitude, and practices among clinicians on the other. Materials and Methods: A total of 357 adult patients with fever of more than 5-day duration were recruited. All patients underwent complete physical examination, and detailed clinical history was elicited as per predesigned pro forma. After primary screening to rule out malaria, enteric fever, and leptospirosis infection, secondary screening for scrub typhus was done by rapid screen test and IgM ELISA. Results: Scrub typhus infection was positive in 91 (25.5%) cases. The most common symptoms among the patients were fever (100%), pain in abdomen (79.1%), pedal edema 56 (61.5%), rash 44 (48.3%), headache 44 (48.3%), vomiting 42 (46.1%), constipation 33 (36.2%), cough 28 (30.7%), and lymphadenopathy 20 (21.9%). The median values of interleukin-8, interferon-gamma, and tumor necrosis factor-alpha in healthy controls were 15.54 pg/ml, 7.77 pg/ml, and 54.1 pg/ml, respectively, while the median values of these cytokines in scrub typhus-positive patients were 21.04 pg/ml, 8.74 pg/ml, and 73.8 pg/ml, respectively. Conclusion: Our results highlight that scrub typhus infection is an important cause of pyrexia of unknown origin, and active surveillance is necessary to assess the exact magnitude and distribution of the disease.

Profiling of Pro-Inflammatory Cytokines in Radiation Induced Oral Mucositis (RIOM) among Indian patients

Radiation-induced oral mucositis (RIOM) is aimed at evaluating the expression of NF-κß, IL-1α, IL-6, IL-8 and TNF-α in patients with RIOM so as to validate their role in the pathobiology of the disease. Blood samples were collected and serum of 45 patients isolated with clinical signs and symptoms of mucositis and 10 healthy controls were also included in the study. The expression level of NF-κß, IL-1α, IL-6, IL-8, TNF-α was investigated using ELISA. Mann Whitney U test was applied to find the significance of the expression of these markers in RIOM patients as compared to normal healthy controls and significant expression (P< 0.05) for NF-κß, IL-6, TNF-α and non-significant expression (P > 0.05) IL-1α and IL-8 was found. No significant change in the expression level of the cytokines was observed for patients undergoing chemotherapy and radiation therapy as well as those receiving only the radiation therapy as a part of their treatment. We have also found less expression in grade 1 of mucositis as compared to grade 4. Pro- inflammatory cytokines indeed play a vital role in the pathogenesis as well as progression of RIOM (AU)

Impact of Olyset nets on malaria transmission in India.

BACKGROUND & OBJECTIVES: Efficacy of Olyset nets, long-lasting insecticidal nets were tested from August 2003 to August 2006 against Anopheles culicifacies, the vector which transmits 60% of all malaria cases in rural India. METHODS: Three villages in District Gautam Budh Nagar (Uttar Pradesh), India were selected for the trial and Olyset nets were distributed in one village, in another village untreated nets were distributed and the third village was kept as control where nets were not used. Entomological, and epidemiological data were collected using standard methods. RESULTS: The use of Olyset nets reduced the indoor resting density of An. culicifacies and also reduced mosquito entry into the structures where Olyset nets were used. No mosquitoes were caught landing on the Olyset nets. There was a reduction in the parity rate of An. culicifacies in the Olyset net village as compared with untreated net and no net villages. The impact of Olyset nets was observed on malaria incidence and only one case of Plasmodiumfalciparum malaria was reported in the Olyset net village but these continued to be found in the village with untreated nets and the control. CONCLUSION: Results of the present study confirmed that Olyset nets are highly effective in reducing the indoor resting density of mosquitoes, man-vector contact and malaria incidence.

Chlamydia trachomatis infection & female infertility.

BACKGROUND & OBJECTIVES: Chlamydia trachomatis is a well recognized sexually transmitted pathogen. Besides its potential to produce genital tract infection, C. trachomatis is increasingly being associated with long-term complications like infertility. The present study was undertaken to assess the role of C. trachomatis in female infertility as such data are lacking. METHODS: Women of primary and secondary infertility (n=110) and 30 healthy term pregnant women as control group were enrolled in the study. Detailed clinical history of each patient was recorded. Hysterosalpingography was performed in all patients. Endocervical swabs were collected for culture on cycloheximide treated McCoy cell line and for antigen detection by ELISA. RESULTS: C. trachomatis was detected in 31 (28.1%) of the 110 infertile women while one (3.3%) in control group was positive for C. trachomatis (P<0.01). Cell culture alone identified 25 (22.72%) patients suffering from chlamydial infection while C. trachomatis antigen was detected by ELISA in 18 (16.37%) patients. The one control case was positive for Chlamydia antigen by ELISA and not by cell culture. Chlamydial positivity was seen in 20 of the 74 (27%) women with primary infertility and in 11 of the 36 (30.6%) with secondary infertility. Of the 58 asymptomatic women, 21(36.2%) had chlamydia infection while among the 52 symptomatic cases 10 (19.2%) were infected; 38 per cent women with chlamydial infection also had tubal occlusion. INTERPRETATION & CONCLUSION: A significantly high rate of C. trachomatis infection was found in infertile women and more so in asymptomatic females and in secondary infertility cases. Lack of symptoms make clinical diagnosis of chlamydial infection difficult. Screening of infertile women for C. trachomatis is therefore recommended so far early therapeutic interventions.

Methicillin resistant Staphylococcus aureus (MRSA): the associated risk factors.

Methicillin Resistant Staphylococcus Aureus (MRSA) infections are common among hospitalized patients in whom surgical/medical therapy provides easy and ample opportunity for infection. The present study was conducted to examine the incidence of MRSA amongst patients from burns and orthopaedic units which are high risk units, and to see the correlation of the risk factors associated with these infections. Four hundred and fifty patients from the above two units were included with complete clinical details. Pus samples/swabs were transported in glucose broth and subsequent identification of MRSA was based on standard techniques. The incidence of MRSA infection was found to be 17.5% while the nasal carriage of this pathogen was seen in 2.9% patients. The risk factors which were found to be significantly associated with these infections were prolonged hospital stay, (16.95+6.7d) previous history of hospitalization during the last three months (38%), intake of broad spectrum antibiotics within the last two weeks (39.2%), prior history of intake of any intravenous drug (6.3%) and carriage of Staphylococcus aureus (30.3%) particularly MRSA (61.5%) in nose. Since these risk factors were found to be significant, it is therefore essential to control and prevent these factors to minimize the spread of these multi drug resistant MRSA infections.