Seasonal, Regional and Demographic Trends in Patients with Acute Undifferentiated Fever in Northern India

Introduction : Acute Undifferentiated Fever (AUF) has a myriad of etiologies most common of which are Vector Borne Diseases in a country like India. The etiology and diagnosis of AUF is driven by the regional disease burden, seasonality of infectious diseases, spectrum and severity of disease, availability of diagnostics and access to health care facilities. Methods : A twelve-month prospective study was conducted at our centre to determine the commonly occurring causes of AUF. Monthly incidence of each of the common etiologies was noted and a graph was plotted to understand the seasonal distribution of each disease. Other parameters including age, gender, occupation and regional distribution were also studied. Results : The mean age (±SD) of the population in the present study was 33.16 (±15.88) years. Our study established that Scrub Typhus, Dengue fever and malaria were the most common reasons for AUF. The maximum incidence of AUF was between the months of June to October, peaking in the month of August. Urban population, younger age and males were more affected by AUF. Haryana followed by Punjab and Chandigarh had the highest regional burden of disease. Conclusion : It is imperative that we understand the seasonal and regional trends of AUF so that we can plan the resource allocation. Identifying the population at risk and timely intervention at Community level may help to reduce disease transmission.

Bacterial Colonization of Home Nebulizers Used by Children With Recurrent Wheeze

Objective: To look for bacterial colonization of parts of home nebulizers used for children with recurrent wheeze and asthma. Methods: Children aged 1 mo-12 y, using home nebulizers for recurrent cough and wheeze were enrolled from May to October, 2019. Caregivers were administered a structured questionnaire by a single researcher, during their hospital visit, to elicit information on their nebulizer cleaning practices. Samples were taken from nebulizer medicine chamber and tubing for bacterial culture and sensitivity. Results: Bacterial growth was observed in 17 culture samples obtained from medicine chamber and/or tubing of nebulizers used by 12 (20.3%) out of the 59 enrolled children. The bacteria isolated were Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus (Methicillin resistant S. aureus and Coagulase negative staphylococci) and these were resistant to many of the commonly used antimicrobials. Almost 20% parents had never cleaned the nebulizers. Diluent re-use was significantly associated with bacterial colonization of nebulizer parts [AOR (95% CI) 20.6 (2.26-188.5); P=0.007]. Conclusion: Home nebulizers, if not cleaned properly as per set protocols, may get colonized with potentially harmful bacteria. There is a need to increase awareness about their proper use amongst parents of children with recurrent wheeze.

Epidemiology & antibiograms of Vibrio cholerae isolates from a tertiary care hospital in Chandigarh, north India.

Background & objectives: Cholera is endemic in Chandigarh and its surrounding areas. This retrospective study was undertaken over a period of nine years (January 1999-December 2007) from a tertiary care hospital in north India to understand the changing epidemiology aspects and antibiotic resistance patterns in Vibrio cholerae isolates. Methods: A total of 277 isolates of V. cholerae were included in the study. V. cholerae was identifi ed by standard microbiological procedures. Antibiotic sensitivity testing was performed by disc diffusion method and isolates phage typed. Results: All the isolates were identifi ed as V. cholerae O1 biotype El Tor serotype Ogawa; phage 27 was the predominant type. Men were more commonly affected with maximum number in the age group 0-5 yr. Majority of the isolates were resistant to furazolidone but sensitive to gentamicin and cefotaxime. Resistance pattern to amoxycillin was variable. Three isolates were found to be resistant to ciprofl oxacin. All the patients presented during June-October coinciding with the monsoon season and a majority were from suburbs. Interpretation & conclusions: The emergence of resistance amongst V. cholerae especially towards ciprofl oxacin may signifi cantly infl uence the control strategies in future outbreaks. Phage 27 remained the predominant type in all the years. Continuous surveillance with regard to drug resistance, early detection and a strong regional commitment may help contain the disease.

Avian Influenza: Current Scenario.

Avian influenza commonly called as 'Bird flu' is a matter of great concern which has caused three major pandemics in twentieth century killing millions of people. Recent epidemic with H5N1 type strain started in 1997 and is still continuing. Disease has assumed new proportions since its confirmed association with migratory birds. In India also, three separate outbreaks have been announced till now by Government of India. This virus has tremendous capacity for gene reassortment and humans by enlarge do not have any immunity against them. This fact has raised global fears of an imminent influenza pandemic. The neuraminidase inhibitors currently are the only drugs which can be used, in case pandemic occurs. Therefore, timely development of an effective influenza vaccine is must and should be made a public health priority.

Keratomycosis in and around Chandigarh: a five-year study from a north Indian tertiary care hospital.

To find out the prevalence and epidemiological features of keratomycosis in Chandigarh, the present study was carried out jointly by the Departments of Microbiology and Ophthalmology, Government Medical College Hospital, Chandigarh, over a period of 5 years from January 1999 to December 2003. Corneal scrapings were collected from a total of 154 suspected patients of keratomycosis and were processed and identified by standard laboratory techniques. The study revealed that a total of 64 cases (41.55%) were positive for fungal agents. Direct microscopy was positive in 52 cases (76.47%) and culture in 34 cases (53.12%). Most common fungal isolates were Aspergillus species 14 (41.18%), Fusarium species 8 (23.53%), Candida species 3 (8.82%), Curvularia species 2 (5.88%) and Bipolaris species 2 (5.88%). Thus, hyaline filamentous fungi were the most common etiological agents and mechanical trauma with vegetative matter was the most common predisposing factor. Males in age group of 21-50 years were more commonly affected.

Isolation of Enterococcus faecalis from a case of nonpuerperal breast abscess.

Nonpuerperal breast abscess (NPBA) has different etiology as compared to the mastitis occurring in post partum women. The condition presents either as acute suppurative infection or chronic type. Organisms usually implicated are Staphylococcus aureus, coagulase negative staphylococci, and anaerobes. Mostly the infection is polymicrobial in nature. Herein, we report the isolation of Enterococcus faecalis from a case of acute suppurative NPBA.

Primary rubella virus infection: prevalence and relationship to pregnancy wastage.

A total of 580 females (200 in prepubertal age and 380 in reproductive age group) were screened for primary rubella infection. Rubella specific serology (IgM and IgG) was studied by ELISA using commercially available diagnostic kits. IgM seropositivity was observed in 56 of 200 females (28%) of prepubertal age and 26 of 380 females (6.84%) in reproductive age group. Out of 380 females in reproductive age, 183 presented with history of adverse pregnancy outcome and they showed a higher percentage of IgM seropositivity (10.38%) as compared to those with normal obstetric performance (3.55%). However, the difference was not statistically significant (p > 0.05). IgG seronegativity was found in 109 females (28.68%) in reproductive age suggesting their susceptibility to acquire primary rubella infection. Five of 380 (0.32%) females were seropositive for both IgG and IgM indicating reinfection.