HIV positivity in TB suspects - An observational, nonrandomized study.

Aims: The present study was carried out to determine the prevalence of TB, HIV, and TB- HIV co-infection in 618 patients who attended the health institute for TB diagnosis and treatment at a rural tertiary care hospital in Punjab. Methods: Pulmonary T.B was diagnosed by sputum smear microscopy, culture and extra-pulmonary TB was diagnosed by X-ray, CT and other methods.HIV diagnosis was made by testing the sera by 3E/R/S (ELISA/RAPID/SIMPLE) tests as per NACO guidelines. Results: Of the total 618 patients, 74(12%) were patients of pulmonary TB, out of whom 72 were diagnosed by Ziehl Neelsen (ZN) staining and two were diagnosed by culture as the ZN stained smear was negative, 169(27.3%) were cases of extra-pulmonary TB. Three out of 618 were HIV positive. 1.23% were TB- HIV co-infected. Conclusion: The risk of developing TB increases in patients with HIV. So, HIV and TB programmes should be collaborated together and should be closely integrated with medical care to curb the spread of these deadly diseases.

Prevalence and antimicrobial susceptibility pattern of methicillin-resistant staphylococcus aureus (MRSA) in a Rural Tertiary Care Hospital in North India.

The emergence of Methicillin-resistant Staphylococcus aureus (MRSA) has posed a serious therapeutic challenge. We report the prevalence and antibiotic susceptibility pattern of MRSA in the hospitalized patients in a rural tertiary care hospital in India. The study comprised of 97 Staphylococcus aureus isolated from a total of 400 clinical samples obtained from hospitalized patients. Antibiotic susceptibility testing was performed and interpreted as per standard guidelines. Methicillin resistance was detected using oxacillin and cefoxitin disc diffusion method, oxacillin screen agar and Chrom agar method, minimum inhibitory concentration using E test, and Latex agglutination method for PBP2a detection.Methicillin resistance with cefoxitin disc diffusion was 47.42%, with oxacillin disc diffusion 54.64%, Oxacillin screen agar 46.34% and Latex agglutination 45.36%. Chrom agar showed low sensitivity (77.27%) as well as specificity (79.25%) in detecting MRSA. MIC detection with E test resulted in 42.27% strains giving MIC between 8-16μg/ml. Multidrug resistance was observed in majority of MRSA strains. However, no strain was resistant to Vancomycin, Linezolid or Teicoplanin. To reduce the prevalence of MRSA, regular surveillance of hospital acquired infection and monitoring of antibiotic susceptibility pattern is the need of the hour. Proper detection of all MRSA with rapid and accurate methods must be done as a routine laboratory procedure.

HIV seroprevalence and HIV associated dermatoses among patients presenting with skin and mucocutaneous disorders.

Background and Aims: Skin and mucocutaneous disorders are common in HIV infection and may be the earliest manifestation of the disease. The spectrum of these disorders is wide and may vary in different regions due to varying prevalence of various microbial agents. Therefore, we studied the seroprevalence of HIV infection in patients presenting with skin and mucocutaneous disorders and clinical and regional epidemiological profile of seropositive patients. Methods: Eleven hundred and seventy patients having any type of skin or mucocutaneous disorders were screened for HIV infection (NACO guidelines) after recording their clinical and epidemiological profile. Results: Of the 1170 patients screened, 38 (3.24%) were found to be positive for HIV 1 and none for HIV 2 antibodies. Seropositive patients belonged to the age group of 9 to 48 years, with a male:female ratio of 0.9:1. Heterosexuality was the most common mode of transmission (86.8%). A wide range of infectious and noninfectious lesions were observed and herpes zoster was the most common infectious disease (31.5%) followed by mucocutaneous candidiasis (26.3%). The most common noninfectious manifestation was seborrhoeic dermatitis (18.4%) followed by pruritic papular eruptions (7.9%). Conclusion: High prevalence and wide variety of skin and mucocutaneous disorders in HIV-positive patients highlight the importance of better vigilance and early suspicion of HIV infection in such patients.

Malaria with marked thrombocytopenia: report of 2 cases.

Two cases of malaria are reported in the article. The patients were referred to CMC and Hospital, Ludhiana as cases of fever presenting with signs and symptoms suggestive of dengue like illness. Both were having fever and low platelet count. One of them was having massive bleeding from the gums. Both of them were found to be have Plasmodium vivax infection and were treated accordingly. Malaria must be considered in a patient having fever and thrombocytopenia so that appropriate treatment is initiated in time to reduce morbidity and mortality.

Comparision of the conventional diagnostic techniques,BACTEC and PCR.

Two hundred and thirty samples from suspected pulmonary and extra pulmonary cases of tuberculosis were processed for detection of Mycobacterium tuberculosis by ZN smear examination, LJ medium culture, BACTEC radiometric culture and Polymerase Chain Reaction tests. A significant difference was seen in the sensitivities of different tests,ie.73.9% for PCR tests,34.78% for ZN smear examination, 52.17% for LJ culture and 58.69% for BACTEC culture. However,there was no significant difference in specificity of different tests(P> 0.05). PCR test sensitivity in pulmonary and extrapulmonary clinical samples was 74.0% and 78.5% respectively and found to be significantly higher (P<0.05) when compared with those of other tests. The mean detection time for M.tuberculosis was 24.03 days by LJ medium culture, 12.89 days by BACTEC culture and less than one day by PCR test.

Bacteriological Profile, Serology and Antibiotic Sensitivity Pattern of Micro-organisms from Community Acquired Pneumonia

A study of 233 consecutive patients with pneumonia was done in the Microbiology Department of the Christian Medical College and Hospital, Ludhiana. Laboratory investigations like blood culture, sputum culture and serology were done to establish the diagnosis. Rates of isolation of organisms from blood culture, sputum culture and serology were 21.9%, 32% and 27.1% respectively. Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella, pneumoniae, other gram negative organisms, fungi like candida albicans and Aspergillus fumigatus were isolated by culture AFB was isolated in 5% of cases. Serology for Mycoplasma and Chlamydia was positive in 16.5% and 17.6% of the patients respectively. An etiological diagnosis was made in 47.7% cases with a definitive evidence in 31% and presumptive evidence in 16.7%. No etiological diagnosis could be made in 52.3% cases. Best antibiotic sensitivity results for organisms isolated from sputum culture were from third generation cephalosporins followed by flouroquinolones and aminoglycosides. Blood culture sensitivities also revealed a similar pattern.

Fungal Profile and Susceptibility Pattern in Cases of Keratomycosis

The present study was undertaken to find out various fungi causing keratomycosis and to determine the antifungal susceptibility profile of these isolates. One hundred corneal scrapings from patients with corneal ulcers were subjected to KOH wet mount preparation. Thirty samples which were positive for fungal elements on direct microscopic examination were cultured on Sabouraud's dextrose agar medium(SDA).The isolates were identified and were subjected to drug susceptibility tests for ketoconazole and fluconazole by tube dilution method. Incidence of fungal corneal ulcers was maximum in the age group of 20-49 years (56.67%). Agriculturists constituted the largest group (53.33%), history of trauma was present in 90% of the patients. Aspergillus species were the commonest isolates (70%) followed by candida (20%), alternaria (6.70%) and penicillium (3.30%). MIC of ketoconazole varied from 0.5mg/ml to 10 mg/ml. MIC of fluconazole varied from 0.5 - 10 mg/ml and 19 isolates of fungi did not show any sensitivity to fluconazole upto concentration of 10 mg/ml which was the upper limit of the test system. As agricultural activity and related ocular trauma were principal causes of mycotic keratitis, KOH wet mount preparation is an essential tool in the diagnosis of these infections. It is a very simple and sensitive method. Susceptibility pattern to antifungal drugs was determined to optimize therapeutic response in eye infections.

HIV-1 infection in early seroconversion stage missed by rapid or ELISA tests--two case reports.

Two cases of HIV-1 infection demonstrating lack of sensitivity of rapid and ELISA screening tests are being reported. The first case was that of a 23 years old female whose recent infection was picked up by ELISA (Tetra ELISA) test but missed by two rapid tests (Comb AIDS and HIV Tridot). The 2nd case presumably too in early seroconversion phase, was that of a 39 years old male. In this case ELISA test failed to diagnose the infection while the two rapid tests were found to be strongly positive.

Prevalence of IgM Antibodies to Toxoplasma, Rubella and Cytomegalovirus Infections During Pregnancy

The present study was conducted to find out the prevalence of IgM antibodies to Toxoplasma, Rubella and Cytomegalovirus in women with Bad Obstetric History (BOH) in and around Amritsar. Over a period of one year, 200 serum samples were collected from pregnant women having BOH and 100 serum samples were collected from pregnant women without BOH. Out of 200 sera, from women with BOH 137 (68.5%) were positive for Toxoplasma, Rubella and CMV alone or in combination. IgM seropositivity to Toxoplasma was 42.5%, Rubella was 17.5% and CMV was 29.5%. The highest percentage of these antibodies to Toxoplasma, Rubella and CMV was in cases of abortions i.e. 71.8%, 59.9% and 61% respectively. The study shows that there is a strong association of these agents with BOH. Thus, screening and early diagnosis for these agents in women can help in proper management of these cases.

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.

Sporotrichosis in Amritsar--a case report.

A case of cutaneous, lymphatic Sporotrichosis, in a farm labourer, is presented. The diagnosis was established by isolating fungus from the lesion. Dimorphic nature of the fungus was established in vitro by demonstrating the mycelial phase at 25-30 degrees C and yeast phase at 37 degrees C. The patient responded well to oral administration of Potassium iodide.

Non-fermenters in human infections.

One thousand and one hundred thirty non-fermenting gram negative bacteria were isolated from various samples. Of these, Pseudomonas aeruginosa was the commonest isolate (72.83%) followed by Acinetobacter anitratus (8.4%), Alcaligenes faecalis (7.6%), Acinetobacter lwoffi (4.4%), Pseudomonas flourescens (2.4%), Schwanella putrefaciens (1.6%), Stenotrophomonas maltophilia (1.6%), Pseudomonas putida (0.4%), Bravundimonas vesicularis (0.4%) and Flavobacterium meningosepticum (0.4%). Antibiotic sensitivity pattern showed multiple drug resistance pattern with majority of the isolates being resistance to two or more drugs.

Characterisation, biotyping, antibiogram and klebocin typing of Klebsiella with special reference to Klebsiella oxytoca.

400 strains of Klebsiellae identified by culture characteristics and biochemical reactions were subjected to biotyping, antibiogram and klebocin typing. Based on indole production, pectin and gelatin liquefaction 16.0% of all the isolates were Klebsiella oxytoca. Maximum sensitivity was shown to Amikacin (72%) and maximum resistance to Ampicillin (87.5%). Klebocin typability was 73.5%. So by combining biotyping, antibiogram and Klebocin typing, Klebsiella could be differentiated better than based on any single marker.

Seroprevalence of Chlamydia trachomatis in women with bad obstetric history and infertility.

50 sera each from women with infertility, bad obstetric history and healthy pregnant women were tested for the presence of antichlamydial IgG antibodies. Antichlamydial IgG antibodies were present in 68% of women with infertility, 50% of women with bad obstetric history and 10% in healthy pregnant women. As culture methods are cumbersome so diagnosis can be made by serological tests, which are sensitive, specific and non invasive. Chlamydia trachohmatis is one of the most common bacterial sexually transmitted disease and most infections caused by Chlamydia trachomatis being asymptomatic, result in a large reservoir of unrecognized, infected individuals capable of transmitting the infection to sexual partners. Chlamydia trachomatis if detected earlier and given proper treatment, can minimize the complications in these patients.