Emergence of multiple drug resistance Vibrio cholerae O1 in East Delhi.

INTRODUCTION: Considering the changing geographical and temporal occurrence of Vibrio cholerae, there is a continuing need to monitor the strain characteristics and antibiotic resistance patterns of this pathogen. The present study was conducted to document the changing biology of V. cholerae isolates in and around Delhi, India, and the development of antibiotic resistance. METHODOLOGY: A total of 1,424 stool samples or rectal swabs from patients with acute secretory diarrhoea admitted to Guru Teg Bahadur Hospital, Delhi, between January 2007 and December 2009 were processed using standard bacteriological methods. Strains identified as V. cholerae were further subjected to serogrouping, phage typing and antimicrobial susceptibility testing. Minimum inhibitory concentration (MIC) of gentamicin and tetracycline was determined. RESULTS: V. cholerae was isolated in 242/1,424 (17.0%) specimens. Of these, the majority were V. cholerae O1 serotype (98.3%) and serovar Ogawa. The drugs to which V. cholerae O1 isolates showed high levels of resistance were nalidixic acid, furazolidone, and cotrimoxazole throughout the study period, whereas strains were usually susceptible to chloramphenicol and cefotaxime. In 2007, there was a sudden increase of resistance to gentamicin and tetracycline, followed by a slow reversal to previous levels in subsequent years. The phage typing pattern (Basu and Mukherjee scheme) showed a dominance of phage type 2 throughout the study period. CONCLUSION: The importance of reporting all cases of V. cholerae, should be greatly emphasized, with the ultimate goal of understanding the constantly changing resistance patterns of this pathogen.

Characterization of patients with multiple sexually transmitted infections: A hospital-based survey.

BACKGROUND: Many studies have examined the inter-relationship between different STI. There are, however, a few data on patients presenting with more than one concurrent sexually transmitted infection (STI). The aim of the study was to determine the burden of patients with more than one concurrent STI and to characterize factors associated with such infections. MATERIALS AND METHODS: Two hundred seventy five patients with one or more of the complaints, as enunciated by the World Health Organization (WHO) in its syndromic approach for the diagnosis of STI, were included as subjects. Detailed history, demographical data, and clinical features were recorded. All the patients were screened for common STIs. Multivariate analysis was performed taking all significant risk factor obtained from univariate analysis. RESULTS: A total of 102 (37%) patients were identified as having multiple STIs amongst whom 72% (73/102) were male, 70% were married, and except one none reported regular use of condom The age of first sexual exposure was 13-17 years, 31.3% had more than three sexual partners in the past 6 months, and 76.4% had contact with commercial sex workers (CSWs). Multivariate analysis revealed statistical significance in relation to marital status, number of sexual partners exposed in the past 6 months, age of first sexual exposure, and age of patient at the time of presentation. Syphilis (48%) was the most common infection associated with multiple STI followed by HIV (45%) and HSV-2 (39.2%). None of the patients with multiple infections were detected and managed accurately by syndromic approach. CONCLUSION: Pattern of concurrent multiple STIs and the clinical severity of such multiple infections may serve as an indicator of the type of host-pathogen interaction determining the outcome of infection. When patient had multiple STIs, syndromic approach was not axiomatic and thus underscores the need for laboratory diagnosis.

Pattern of sexually transmitted infections and performance of syndromic management against etiological diagnosis in patients attending the sexually transmitted infection clinic of a tertiary care hospital.

BACKGROUND AND OBJECTIVES: The availability of baseline information on the epidemiology of sexually transmitted infections (STIs) and other associated risk behaviors is essential for designing, implementing, and monitoring successful targeted interventions. Also, continuous analysis of risk assessment and prevalence-based screening studies are necessary to evaluate and monitor the performance of syndromic management. The aim of the present study was to document the pattern of common STIs and to evaluate the performance of syndromic case management against their laboratory diagnoses. MATERIALS AND METHODS: Three hundred consecutive patients who attended the STI clinic of a tertiary care hospital at Delhi, with one or more of the complaints as enunciated by WHO in its syndromic approach for the diagnosis of STIs, were included as subjects. Detailed history, demographical data, and clinical features were recorded and screened for common STIs by standard microbiological methods. RESULTS: The mean age was 24 years and most of the male patients were promiscuous and had contact with commercial sex workers (CSWs 63.9%). Majority came with the complaint of genital discharge (63 males; 54 females) followed by genital ulcer (61 males; 30 females). Genital herpes accounted for the maximum number of STI (86/300) followed by syphilis (71/300). The sensitivity of genital discharge syndrome (GDS) was high for Neisseria gonorrhoeae and Chlamydia trachomatis (96% and 91%, respectively) while specificity was low (76% and 72%, respectively). The sensitivity of genital ulcer syndrome for herpes simplex virus-2 (HSV-2) and Treponema pallidum was 82.65% and 81.2%, respectively, while specificity reached 99% approximately. CONCLUSIONS: Viral STIs constitute the major burden of the STI clinic and enhance the susceptibility of an individual to acquire or transmit HIV through sexual contact. Syndromic algorithms have some shortcomings, and they need to be periodically reviewed and adapted to the epidemiological patterns of STI in a given setting.

Serological profile of HSV-2 in patients attending STI clinic: evaluation of diagnostic utility of HSV-2 IgM detection.

OBJECTIVE: The present study was done to evaluate the serological profile of herpes simplex virus-2 (HSV-2) among patients attending sexually transmitted infections (STI) clinic and to determine the utility of detecting HSV-2 IgM antibodies in such patients. A correlation of HSV-2 infection with other STI including HIV has also been attempted. MATERIALS AND METHODS: Hundred consecutive patients who attended STI clinic, with one or more of the complaints as enunciated by WHO in syndromic approach for the diagnosis of STI, were included as subjects. All subjects were screened for common STI by standard laboratory procedures/ commercially available kits. HSV-1 and HSV-2 IgM antibody was detected by commercially available enzyme immuno assay kit in all patient's sera. Sera were also tested for other STI, namely HIV, Hepatitis B virus, Hepatitis C virus and Treponema pallidum. Antigen detection for Chlamydia trachomatis was done in genital swabs of all patients by Bio-Rad Chlamydia Microplate EIA 31189 (United States) kit. RESULTS: Thirty patients were found to have genital herpes. In 17/30 (56.6%) patients, HSV-2 serology was found to correlate with the clinical diagnosis. The coexistence of other infection in HSV-2 seropositive patients was detected in 8/30 patients. None of the patients having concomitant infections were clinically diagnosed accurately. Sensitivity, specificity, positive predictive value and negative predictive value of IgM antibodies for the diagnosis of genital herpes was 73.91%, 90.91%, 70.83% and 92.91% respectively. CONCLUSION: HSV-2 IgM detection could only be used as a supportive test for the diagnosis of genital herpes . It needs to be emphasized that the sensitivity and positive predictive value scores are pointers for further improvement in the commercial assay systems and a large sample size may determine the broader utility of such systems.