Antimalarial drug policy in India: Past, present & future.

The use of antimalarial drugs in India has evolved since the introduction of quinine in the 17th century. Since the formal establishment of a malaria control programme in 1953, shortly after independence, treatments provided by the public sector ranged from chloroquine, the mainstay drug for many decades, to the newer, recently introduced artemisinin based combination therapy. The complexity of considerations in antimalarial treatment led to the formulation of a National Antimalarial Drug Policy to guide procurement as well as communicate best practices to both public and private healthcare providers. Challenges addressed in the policy include the use of presumptive treatment, the introduction of alternate treatments for drug-resistant malaria, the duration of primaquine therapy to prevent relapses of vivax malaria, the treatment of malaria in pregnancy, and the choice of drugs for chemoprophylaxis. While data on antimalarial drug resistance and both public and private sector treatment practices have been recently reviewed, the policy process of setting national standards has not. In this perspective on antimalarial drug policy, this review highlights its relevant history, analyzes the current policy, and examines future directions.

Comparison of HIV Antibody Detection by Conventional Method and Dried Tube Specimen : Stability and Validation Study for HIV Serology.

This study was carried out to compare HIV antibody detection by conventional method and serum dried in test tube and to check the stability of dried tube specimen (DTS) at ambient temperature. A total of 50 serum samples were tested for HIV antibodies, which were sent for testing in the state reference laboratory, by conventional method according to NACO guidelines. The same serum samples were dried in test tubes and then after elution with PBS again tested for HIV antibodies by same method and kits at 0 day and after 30 days. DTS eluted by PBS showed linear correlation to the serum samples. The antibodies in DTS were found to be stable at 37o c up to 30 days. This method is simple, sensitive and specific and can be used in resource limited settings embarking on scaling up of HIV testing.

Prevalence of Nonfermentative Gram Negative Bacilli In Seriously ill Patients With Bacteraemia.

Bacteraemia due to nonfermentative gram negative bacilli appears to be increasing in frequency particularly in hospitalized patients with severe underlying illness. A total of 159 (79.50%) organisms were isolated from blood cultures of 200 seriously ill patients. Out of these, 73 (45.91%) were nonfermentative gram negative bacilli. Pseudomonas aeruginosa was the commonest isolate (32.88%) followed by Acinetobacter spp. (23.28%) and Burkholderia cepacia (10.96%). Analysis of antimicrobial susceptibility testing showed multidrug resistant pattern with majority of the isolates being resistant to three or more drugs.

Cellphones A Modern Stayhouse For Bacterial Pathogens.

Cellphones are increasingly used by health care personnels for communication. These can harbour various potential pathogens and become an exogenous source of nosocomial infections. A total of 160 cellphones belonging to doctors and paramedical staff working in various departments at govt. medical college and hospital, Amritsar were screened for bacterial isolates. Sterile swabs moistened with nutrient broth were used to swab the front, back and the sides of the cellphones and were subjected to culture and sensitivity. The same procedure was repeated after decontamination with 70% iso propyl alcohol.Out of total 160 cellphones growth was obtained in 65(40.62%) cellphones. 31(19.37%) from clinical workers and 34(21.25%) from non clinical workers. Coagulase negative staphylococcus was the most commonly isolated organism.The efficacy of decontamination with 70% isopropyl alcohol was found to be 98% as only 5 cellphones showed growth after decontamination.It was found that around 40% of the cellphones of health care workers were contaminated and thus acted as a potential source of nosocomial infections. Simple measures like decontamination with 70% isopropyl alcohol was found to be 98% effective.

Seroprevalence of human immunodeficiency virus-2 in and around Amritsar.

A total of 14555 serum samples collected between January, 2001 to April, 2006 were screened for HIV infection. Antibodies to HIV-1/ HIV-2 were present in 985 (6.76%) of which 964 (97.86%) and 2 (0.22%) were positive for HIV-1 and HIV-2 alone respectively and 19 (1.92 %) for both HIV-1 and HIV-2. Of the 21 in whom HIV-2 infection was detected (alone and dual), 19 (90.5%) were in the age group of 21-40 years and 2 were children below the age of 11 years. Predominantly mode of transmission in them was heterosexual (85.71%) while the 2 children (9.53%) had most probably got the infection through perinatal route. Nine (42.85%) were asymptomatic and 12 (57.15%) clinically presented with chronic diarrhoea (5), prolonged fever (4) and symptoms related to sexually transmitted diseases (3). Opportunistic infections like Oral candidiasis was observed in 3 and pulmonary tuberculosis in 2.

Bacterial Profile of Blood Stream Infections and Antibiotic Resistance Pattern of Isolates.

Blood samples from 2542 clinically diagnosed cases of septicemia were processed. Out of these 946 (76.55%) were from Pediatric Department and rest from other Departments. Growth was obtained in 509(20.02%) cases . Candida spp were isolated from 23 (4.57 ) cases Out of 486 bacterial isolates 52.67 % were gram positive bacteria whereas 47.33% were gram negative bacilli . Staph aureus 133 (27.37%)was the predominant organisms followed by CONS 98 (20.1%). Amongst gram negative organisms Enterobacter 69 (14.19 %) was the most predominant followed by Esch coli 45 (9.27 %) Pseudomonas 37 (7.62 %) and Acinetobacter spp 34 (6.69 %). Amongst gram positive organisms maximum resistance was seen with ampicillin (74.61%) and erythromycin (69.67 %). Most of the gram negative bacilli were MDR (71%). Maximum resistance was observed with ampicillin (86.1% ) cephalexin (68.07%) and piperacillin (57.71%). Most successful drugs were amikacin,gentamicin and cefotaxime. 34.35% of the isolates were ESBL producers.

Extended spectrum beta lactamase--mediated resistance among isolates of family Enterobacteriaceae.

The emergence and spread of extended spectrum beta lactamase (ESBL) producing strains have led to questions regarding optimal therapy for infections especially empirical treatment of suspected gram negative infection. A total of400 isolates belonging to family enterobacteriaceae were isolated from various clinical samples and were studied for ESBL production by NCCLS (National Committee for Clinical Laboratory Standards) confirmatory test (using disc diffusion technique) and MIC brott dilution test. ESBL production was found in 61.72% of hospital isolates and 30.90% of outdoor isolates. The susceptibility of ESBL producers to imipenem and amikacin was found to be 100% and 63.38% respectively. A high degree of associated resistance to other antimicrobial was found in ESBL producers. Tests for detection of ESBLs and continuous monitoring of antimicrobial sensitivity pattern in individual setting is emphasized to minimise the emergence of drug resistant bacteria.

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.

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.

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.