Evaluation of procalcitonin as a diagnostic marker in neonatal sepsis.

CONTEXT: Neonatal sepsis is an early infection occurring within 28 days of the postnatal life. It has nonspecific signs and symptoms which make the diagnosis cumbersome. It inflicts an increase in morbidity and mortality among neonates. Procalcitonin (PCT) is yet another acute phase reactant, which is synthesized by the C-cells of thyroid gland. AIMS: The aim of our study is to evaluate PCT as a diagnostic marker of neonatal sepsis in comparison with C-reactive protein (CRP). SUBJECTS AND METHODS: A prospective cross-sectional study was conducted at our tertiary care hospital in Puducherry. The study was conducted over a period of 5 months from November 2015 to 2016. The study included all neonates with clinical signs of sepsis. The neonates were assigned into three groups as proven sepsis, suspected sepsis, and no sepsis group. The CRP level and PCT level were compared between the three groups, and their sensitivity and specificity were calculated. STATISTICAL ANALYSIS USED: The mean, standard deviation, and standard error of mean were calculated. The groups were compared using one-way ANOVA. The diagnostic test efficiency was evaluated by receiver operating characteristic curve analysis. RESULTS: A total of 75 neonates were included in our study. There were 9 (12%) neonates with proven clinical sepsis, 47 (62.6%) neonates with suspected clinical sepsis, and 19 (25.3%) neonates with no sepsis. The mean and standard error of mean were calculated for CRP and PCT in all the three groups. The results showed a sensitivity of 88.90% for both CRP and PCT and specificity of 89.40% for CRP and 80.30% for PCT. The common organisms isolated from culture-positive group were Escherichia coli (22.2%), Pseudomonas aeruginosa (22.2%), and Candida albicans (22.2%), followed by Klebsiella pneumoniae, Acinetobacter baumannii, and methicillin-resistant Staphylococcus aureus. CONCLUSIONS: PCT may not be sufficiently used as a sole marker of sepsis in neonates compared to CRP. PCT in conjunction with CRP and other tests for septic screen can aid in better diagnosis of neonatal sepsis.

Detection of ISAba1 in association with a novel allelic variant of the ß-lactamase ADC-82 and class D ß-lactamase genes mediating carbapenem resistance among the clinical isolates of MDR A. baumannii.

PURPOSE: The objective of the present study is to investigate the diverse resistance determinants, their association with insertion sequence mobile elements and predilection of a particular clone for such associations in Acinetobacter baumannii. METHODOLOGY: Fifty-four consecutive isolates collected during 2011-2012 from a tertiary care hospital were subjected to susceptibility testing followed by PCR screening of commonly reported ß-lactamases and 16S rRNA methyltransferase encoding genes. The integrity of resistance-nodulation-cell division efflux pump-related genes in their respective operons was also investigated. RESULTS: ß-Lactamase genes such as blaADC (100 %), blaOXA-23 (81 %), blaPER-1 (81 %), blaIMP-1 (31 %) and blaNDM-1 (15 %) were found to be present more frequently while blaVIM-2 and blaOXA-24 were not observed in our study population. ISAba1 was associated only with blaOXA-51-like like (30 %), blaOXA-23-like (55 %) and blaADC-like (33 %). armA was found in 87 % of isolates and ISAba1 linked with one novel variant of ADC, namely blaADC-82, which was identified to have 15 nucleotide differences with blaADC-79, and this finding is of much significance. In many isolates, efflux pump genes were not intact, resulting in severely altered effluxing functions. For the first time, we have identified ISAba1-mediated disruption of adeN among the isolates of ST 195B, which would have led to overexpression of AdeIJK efflux pump causing elevated resistance. Multilocus sequence typing revealed the predominance of CC 92B (IC-IIB) and CC 447B clonal complexes. CONCLUSION: High incidence of IC-II clones, novel resistance determinants (ADC-82) and elevated resistance mediated by ISAba1 reported here will be of enormous importance while assessing the emergence of extremely resistant A. baumannii in India.

Emergence of carbapenem non-susceptible multidrug resistant Acinetobacter baumannii strains of clonal complexes 103(B) and 92(B) harboring OXA-type carbapenemases and metallo-ß-lactamases in Southern India.

The molecular epidemiology and carbapenem resistance mechanisms of clinical isolates of Acinetobacter baumannii obtained from a south Indian tertiary care hospital were investigated by repetitive extragenic palindromic sequence PCR (REP-PCR) and multi-locus sequence typing (MLST). Analysis of resistant determinants was achieved by PCR screening for the presence of genes encoding OXA-carbapenemases, metallo-ß-lactamases (MBLs) and efflux pumps. REP-PCR generated around eight clusters of high heterogeneity; of these, two major clusters (I and V) appeared to be clonal in origin. Analysis of representative isolates from different clusters by MLST revealed that most of the isolates belonged to sequence type 103 of CC103(B) . Second most prevalent ST belonged to clonal complex (CC) 92(B) which is also referred to as international clone II. Most of the isolates were multi-drug resistant, being susceptible only to polymyxin-B and newer quinolones. Class D ß-lactamases such as blaOXA-51-like (100%), blaOXA-23-like (56.8%) and blaOXA-24-like (14.8%) were found to be predominant, followed by a class B ß-lactamase, namely blaIMP-1 (40.7%); none of the isolates had blaOXA-58 like, blaNDM-1 or blaSIM-1 . Genes of efflux-pump adeABC were predominant, most of isolates being biofilm producers that were PCR-positive for autoinducer synthase gene (>94%). Carbapenem non-susceptible isolates were highly diverse and present throughout the hospital irrespective of type of ward or intensive care unit. Although previous reports have documented diverse resistant mechanisms in A. baumannii, production of MBL and OXA-type of carbapenamases were found to be the predominant mechanism(s) of carbapenem resistance identified in strains isolated from Southern India.

Hymenolepis diminuta infection in a school-going child: A rare case report.

Hymenolepis diminuta (H. diminuta) is a common parasite of rats and mice. It is very rare among humans. The life cycle of this parasite is completed in two hosts. Human beings are accidentally infected due to ingestion of infected fleas. Most of the time human infections are asymptomatic. We report a case of Hymenolepis diminuta infection in a school-going 10-year-old girl from a coastal village in south Tamil Nadu. Demonstration of H. diminuta eggs in the stool is the important diagnostic tool. Absence of polar filaments confirms the Hymenolepis diminuta. Praziquantal is the drug of choice.