ABSTRACT
Background: Battle against malaria has been going on since time immemorial. Understanding the true burden of disease and the determinants of its transmission are important for implementing adequate control measures. This study intends to explore the local epidemiology and burden of malaria in Puducherry, a coastal Union territory located in the Southern part of India over a period of 7 years. Methodology: A retrospective record-based study was conducted from 2015 to 2021, where details from all samples that tested positive for malaria by peripheral blood examination or rapid card test, from suspected cases were collected and analyzed. Results: The overall prevalence of malaria over the 7 years was 1.7% (257/14,888). Majority of the patients were male (75.88%) and the major age group affected was from 21 to 40 years (56.03%). The disease was maximum seen during the monsoon season followed by the post-monsoon season. Vivax malaria predominated irrespective of the gender, seasonal change, and different age groups except in children <10 years was both falciparum and vivax malaria were seen in equivalence. The major species to cause infection among infants were Plasmodium falciparum (3/4). Discussion and Conclusion: This study shows a declining trend of malaria transmission over the years. There is no change in the predominant species affected or seasonal trends over the years. The possibility of underestimation of cases due to various factors cannot be ignored.
ABSTRACT
Corynebacterium freneyi is a recently described coryneform bacteria. It is only rarely identified from clinical specimens and its pathogenic significance has not been well studied. Here we report the isolation of the species from the throat swab of a patient with suspected diphtheria. The morphology on direct microscopy and culture also closely resembled Corynebacterium diphtheriae, which almost led to misidentification. The prompt clinical and microbiological response suggests a probable pathogenic role. This is the first report of the isolation of this species from an oropharyngeal sample.
ABSTRACT
Context Clostridioides difficile infection (CDI) is one of the most common infectious causes of hospital-acquired diarrhea. The actual burden of the disease is underestimated in India due to inadequate diagnostic methods and limited studies conducted. Aims The aim of this study was to determine the burden and risk factors of CDI among patients with hospital-acquired diarrhea. Methods and Materials Stool specimen of patients (age > 1 year) with hospital-acquired diarrhea were screened for glutamate dehydrogenase antigen and toxin using an enzyme immunoassay. If both antigen and toxin were present, it was reported as positive for toxigenic CDI. Samples positive for antigen and negative for toxin were further tested with Cepheid GeneXpert assay for detecting the toxin producing gene. Results Of 75 patients (mean age 36.07 ± 20.79, 64% males), 14 (18.67%) patients were positive for toxigenic Clostridioides difficile ( C. difficile ) and 3 (4%) patients were nontoxigenic C. difficile . Addition of GeneXpert to the testing algorithm increased the yield of toxin detection in 5/14 patients who were negative by toxin assay. On analysis of risk factors, prolonged hospital stay was found to have significant association ( p -value = 0.022). Patients with factors like intensive care unit stay, presence of diabetes mellitus as a comorbidity, and exposure to antibiotics like carbapenems and glycopeptides have been found to have a higher prevalence of CDI. Conclusions The prevalence of CDI in our population was 18.67% and the major risk factor associated was prolonged hospital stay. The addition of GeneXpert for the detection of toxin gene increased the yield from 12 to 18.68%.
ABSTRACT
BACKGROUND: Rapid turnaround time of blood culture reports should be the main motive for a clinical microbiologist for optimal patient care. Categorical agreement (CA) between direct disk diffusion (dDD) and reference disk diffusion (rDD) may vary between laboratories. AIMS AND OBJECTIVES: This study was designed to determine the CA and understand various types of errors associated with antibiotic organism combination, so that caution can be derived while interpreting and reporting dDD results in the earliest meaningful time frame. MATERIALS AND METHODS: In the present study, dDD results were compared to the rDD results from the positive blood culture bottles. CA and various types of errors were evaluated. RESULTS: A total of 965 pathogens and 7106 organism antibiotic combinations were evaluated in this study. Overall, there was a CA of 96% which was extremely satisfactory. The categorical disagreement was found only in 4% of organism antibiotic combinations; majority of which were major error (ME, 2.1%) followed by very ME (1%) and minor error (0.9%). The errors were marginally high for Enterobacteriaceae testing against ß lactam- ß lactamase inhibitor combinations, for Pseudomonas species against aminoglycosides and ciprofloxacin and Staphylococcus species against cefoxitin, one should be vigilant while reporting dDD result of these antibiotic organism combinations. CONCLUSION: dDD is of paramount importance for early institution of targeted therapy and is considered as one of the key stewardship intervention. Our study gives an insight that every laboratory must perform dDD for positively flagged blood culture specimens; the result of which should be confirmed later by performing rDD. One should be vigilant while reporting dDD result of BL BLI for Enterobacteriaceae; aminoglycosides and CF for Pseudomonas species; cefoxitin for Staphylococcus species and HLG for Enterococcus species. Supplementary tests such as MRSA latex should be included when necessary.
