Neonatal listeriosis: a case report from sub-Himalayas.

Perinatal listerial infection is the most common clinical syndrome caused by Listeria monocytogenes and includes abortion, still birth, neonatal sepsis, and meningitis. Reports of listeriosis from India are limited. Sub Himalayan . We report a case of neonatal listeriosis from Himachal Pradesh. A two-day-old full term male baby was referred from a peripheral hospital with fever listlessness, skin rash and non-acceptance of feed. Ceftriaxone was already started as an empirical therapy. Listeria monocytogenes was isolated from cerebrospinal fluid (CSF) and blood of the baby, and also from the genital tract of the mother. Unfortunately, the baby died before the preliminary report could be communicated.

Importance of newborn hearing screening.

US Preventive Services Task Force recommends universal screening of all newborns for early detection of hearing impairment and early intervention to prevent its effects on normal development and acquisition of language skills. During comparison of universal screening of all newborns versus targeted screening of high risk cases to detect hearing impairment, it emphasized the importance of Universal newborn hearing screening (UNHS) among neonatologists, pediatricians as well as ENT specialists taking care of newborns and young children. Among those who had early versus late confi rmation of hearing loss and those who had undergone universal newborn screening versus none, better language outcomes at school age were found than those not screened. Infants identifi ed with hearing loss through universal newborn screening had earlier referral, diagnosis, and treatment than those not screened. Targeted screening of newborns with high risk criteria missed 50% of cases of hearing impairment, either because infants were hearing impaired but did not meet any of the high- risk criteria, or because they developed hearing loss after the newborn period.

Primary amoebic meningoencephalitis due to Naegleria fowleri.

Primary amoebic meningoencephalitis (PAM) due to Naegleria fowleri was detected in a 36-year-old, Indian countryman who had a history of taking bath in the village pond. He was admitted in a semi comatosed condition with severe frontal headache, neck stiffness, intermittent fever, nausea, vomiting, left hemiparesis and seizures. Computerized tomography (CT) scan of brain showed a soft tissue non-enhancing mass with erosion of sphenoid sinus. However CSF findings showed no fungal or bacterial pathogen. Trophozoites of Naegleria fowleri were detected in the direct microscopic examination of CSF and these were grown in culture on non-nutrient agar. The patient was put on amphotericin-B, rifampicin and ceftazidime but his condition deteriorated and was taken home by his relatives in a moribund condition against medical advice and subsequently died. A literature review of 7 previous reports of PAM in India is also presented. Four of theses eight cases were non lethal. The mean age was 13.06 years with male: female ratio of 7:1. History of contact with water was present in four cases. Trophozoites could be identified in all 8 cases in this series.

Enhancement of ethyl propionate synthesis by poly (AAc-co-HPMA-cl-MBAm)-immobilized Pseudomonas aeruginosa MTCC-4713, exposed to Hg2+ and NH4+ ions.

A purified alkaline thermo-tolerant bacterial lipase from Pseudomonas aeruginosa MTCC-4713 was immobilized on a poly (AAc-co-HPMA-cl-MBAm) hydrogel. The hydrogel-bound lipase achieved 93.6% esterification of ethanol and propionic acid (300 mM: 100 mM) into ethyl propionate at temperature 65 degrees C in 3 h in the presence of a molecular sieve (3 angstroms). In contrast, hydrogel-immobilized lipase pre-exposed to 5 mM of HgCl2 orNH4Cl resulted in approximately 97% conversion of reactants in 3 h into ethyl propionate under identical conditions. The salt-exposed hydrogel was relatively more efficient in repetitive esterification than the hydrogel-bound lipase not exposed to any of the cations. Moreover, bound lipase exposed Hg2+ or NH4+ ions showed altered specificity towards p-nitrophenyl esters and was more hydrolytic towards higher C-chain p-nitrophenyl esters (p-nitrophenyl laurate and p-nitrophenyl palmitate with C 12 and C 16 chain) than the immobilized lipase not exposed to any of the salts. The later showed greater specificity towards p-nitrophenyl caprylate (C 8).

Purification of a moderate thermotolerant Bacillus coagulans BTS1 lipase and its properties in a hydro-gel system.

An alkaline thermotolerant lipase of Bacillus coagulans BTS1 was successively purified by ammonium sulfate precipitation and DEAE anion exchange chromatography. The purified lipase immobilized in alginate beads showed an optimal activity at pH 7.5 and 55 degrees C. A pH of 5.0 or 10.0 completely quenched the activity of immobilized lipase. The alginate-bound lipase retained its activity following exposure to most of the organic solvents including amines, alkanes and alcohols. Chloride salt of Al3+, Co2+, Mg2+ and NH4+ modulated the lipase activity of alginate-immobilized enzyme. The alginate entrapped lipase showed a preferentially high activity towards p-nitrophenyl palmitate (C: 16) and activity of matrix increased following exposure to SDS. Moreover, the immobilized lipase retained more than 50% of its activity after 3rd cycle of reuse.

Purification and properties of a novel extra-cellular thermotolerant metallolipase of Bacillus coagulans MTCC-6375 isolate.

A novel extra-cellular lipase from Bacillus coagulans MTCC-6375 was purified 76.4-fold by DEAE anion exchange and Octyl Sepharose chromatography. The purified enzyme was found to be electrophoretically pure by denaturing gel electrophoresis and possessed a molecular mass of approximately 103 kDa. The lipase was optimally active at 45 degrees C and retained approximately 50% of its original activity after 20 min of incubation at 55 degrees C. The enzyme was optimally active at pH 8.5. Mg2+, Cu2+, Ca2+, Hg2+, Al3+, and Fe3+ at 1mM enhanced hydrolytic activity of the lipase. Interestingly, Hg2+ ions resulted in a maximal increase in lipase activity but Zn2+ and Co2+ ions showed an antagonistic effect on this enzyme. EDTA at 150 mM concentration inhibited the activity of lipase but Hg2+ or Al3+ (10mM) restored most of the activity of EDTA-quenched lipase. Phenyl methyl sulfonyl fluoride (PMSF, 15 mM) decreased 98% of original activity of lipase. The lipase was more specific to p-nitrophenyl esters of 8 (pNPC) and 16 (pNPP) carbon chain length esters. The lipase had a Vmax and Km of 0.44 mmol mg(-1)min(-1) and 28 mM for hydrolysis of pNPP, and 0.7 mmol mg(-1)min(-1) and 32 mM for hydrolysis of pNPC, respectively.

Transcutaneous bilirubinometer in assessment of neonatal jaundice in northern India.

This study was undertaken from April 2002 to March 2003 to find out the correlation of transcutaneous bilirubinometer index with serum bilirubin levels in term, pre-term, small for gestation age babies, with and without phototherapy in neonates with jaundice. Another aim was to evaluate the transcutaneous bilirubinometer as a screening device for neonatal hyperbilirubinemia by finding the action levels for TcBI at forehead and sternum at which sample for serum bilirubin estimation should be taken. A total of 104 neonates were evaluated. Mean (SD) age (hours), birth weight (grams) and gestational age (weeks) were 100.4 (37.90), 2264.9 (634.4) and 36.8 (2.9) respectively. Mean serum bilirubin was 16.6 (6) mg/dL. Overall a correlation coefficient of 0.878 at forehead and 0.859 at sternum was observed. On excluding infants receiving phototherapy coefficients of 0.900 at forehead and 0.908 at sternum were noted. Correlation coefficient over forehead and sternum was found to drop from 0.85 to as low as 0.33 with duration of phototherapy exceeding 48 hrs. Lastly the determined action levels had a sensitivity of 77.8 to 100 % in assessing the need for serum bilirubin estimation in various groups.

Pansinusitis due to Sporothrix schenckii.

Summary A case of mucocutaneous sporotrichosis presenting as mycotic pansinusitis with polyposis with intracranial and intraorbital extension in a patient from Punjab, India is described. The patient had nasal discharge, sneezing and nasal obstruction for 12 years, had undergone repeated surgeries (for endoscopic clearance) but had recurrence. Computerized tomography (CT) and magnetic resonance imaging (MRI) findings revealed pansinusitis. A definitive diagnosis of sporotrichosis was established by culture of Sporothrix schenckii, verification of its dimorphic character and a positive pathogenicity test. The patient was successfully treated with potassium iodide and itraconazole.

Properties of an immobilized lipase of Bacillus coagulans BTS-1.

Lipase (EC 3.1.1.3) is a tri-acylglycerol ester hydrolase, catalysing the hydrolysis of tri-, di-, and mono-acylglycerols to glycerol and fatty acids. To study the effect of adsorption of a lipase obtained from Bacillus coagulans BTS-1, its lipase was immobilized on native and activated (alkylated) matrices, i.e. silica and celite. The effect of pH, temperature, detergents, substrates, alcohols, organic solvent etc. on the stability of the immobilized enzyme was evaluated. The gluteraldahyde or formaldehyde (at 1% and 2% concentration, v/v) activated matrix was exposed to the Tris buffered lipase. The enzyme was adsorbed/entrapped more rapidly on to the activated silica than on the activated celite. The immobilized lipase showed optimal activity at 50 degrees C following one-hour incubation. The lipase was specifically more hydrolytic to the medium C-length ester (p-nitro phenyl caprylate than p-nitro phenyl laurate). The immobilization/entrapment enhanced the stability of the lipase at a relatively higher temperature (50 degrees C) and also promoted enzyme activity at an acidic pH (pH 5.5). Moreover, the immobilized lipase was quite resistant to the denaturing effect of SDS.

Role of C-reactive protein in deciding duration of antibiotic therapy in neonatal septicemia.

In this study serum C-reactive protein (CRP) levels were used to evaluate the duration of antibiotic therapy in 50 consecutive neonates with suspected septicemia. In 44 percent of cases therapy was stopped on 3rd day, as CRP was normal. In 8 percent antibiotics could be stopped within 5-7 days as CRP values returned to normal and in 48 percent therapy was extended beyond 7th day, as CRP values were high or rising persistently. Negative predictive value of serial CRP was 100 percent in deciding duration of antibiotic therapy in suspected neonatal septicemia up to 7 days. The correlation between positive CRP, raised micro ESR and positive blood culture was significant (p < 0.005).

Risk of seizures and neurocysticercosis in household family contacts of children with single enhancing lesions.

A small, single enhancing lesion (SEL) is often noted upon computed tomography (CT) in children and young adults with recent focal or generalized seizures. A high frequency of seizures has been reported in family members of persons with SEL. We studied the prevalence of seizures and cysticercus electro-immuno-transfer blot (EITB) based seropositivity among family members, specifically household family contacts of pediatric subjects with a SEL. An attempt was also made to determine the etiology of seizures in household family contacts using magnetic resonance imaging (MRI). Information regarding seizure semiology, personal and food habits and detailed family pedigrees was obtained from 20 consecutive pediatric subjects with a SEL and 51 of their household family contacts. EITB sero-assays and stool examinations were performed on all participating subjects. MRIs were done on all EITB positive household family contacts. A family history of seizures was obtained in six index children (30%) (five household first-degree relatives and two distant relatives). Seventeen index children (85%) and 14 family contacts (27%) were EITB positive. A tendency towards clustering of EITB positive cases within individual families was observed. Stool examinations did not reveal Taenia species ova in any of EITB positive subjects. Neuroimaging studies revealed abnormalities consistent with active or inactive neurocysticercosis in all five household family contacts with history of seizures. Four of these five subjects were EITB positive and one was EITB negative. We concluded that children with SEL and seizures may have a family history of seizures. There is a high seropositivity rate in household family contacts of pediatric subjects with solitary cysticercus granulomas (SCGs). EITB based seropositivity in household family contacts with seizures, strongly predicts a cysticercal etiology for seizures. It may be worthwhile to screen household family contacts of children with SEL for taeniasis-cysticercosis.

Childhood trichobezoar.

Two cases of trichobezoar with unusual presentation in rural female children are described. The first one in a healthy asymptomatic child with no abnormal psychological behaviour and other one in an emotionally disturbed child with history of trichotillomania. Both were treated surgically with no recurrence. A physical sign of indentibility is discussed and literature is also reviewed.

Cysticercus immunoblot assay in patients with single, small enhancing lesions and multilesional neurocysticercosis.

A single, small (< 20 mm), ring or disc shaped contrast enhancing lesion located at the cortical-subcortical junction with minimal or no surrounding edema on computed tomography is the commonest mode of presentation of neurocysticercosis in the Indian subcontinent. Serum samples of 37 patients with these single, small enhancing lesions (SSEL's) and five patients with typical multilesional parenchymal neurocysticercosis were tested by the electro-immunoblot transfer (EITB) assay and the enzyme linked immunosorbent assay (ELISA). EITB was positive in 18 patients (48.64%) and ELISA was positive in 21 patients (56.76%) with SSEL's. On the other hand EITB was positive in all five patients (100%) and ELISA was positive in four patients (80%) with multilesional neurocysticercosis. The low sensitivity of the EITB in the SSEL's is probably linked to an insufficient immune stimulation provided by a single cysticercus cyst.

Experience with diarrhea training and treatment unit in Shimla.

PIP: India's National Program for Control of Diarrheal Diseases has established Diarrhea Training and Treatment Units (DTUs) to reduce diarrhea-related morbidity and mortality. The cost-effectiveness and impact of oral rehydration therapy (ORT) were evaluated prospectively in all children presenting to the DTU of I.G. Medical College (Shimla, India) in 1993-94. During the 2-year study period, a total of 1240 children 1 month to 12 years of age attended this DTU for treatment. 47.6% were infants and 58% came from rural areas. 87% of patients had acute watery diarrhea, 10.4% had dysentery, and 2.6% had persistent diarrhea. Diarrhea was most prevalent (74.9%) from April to September. 41.9% of presenting children had received ORT before coming to the DTU; as a result, severe dehydration was seen in only 10.7% of cases. Comparison of data on 166 children admitted to the study hospital in 1986-87 (before ORT was introduced) and the 1993-94 cases revealed significant declines in the admission rate due to dehydration and/or associated illnesses (100% vs. 26.8%), use of antimicrobials (66.2% vs. 15.3%), administration of intravenous fluids (71.1% vs. 15.45%), and mortality (9.03% vs. 0.6%). 84.6% of children in 1993-94 were treated with ORT alone. The average cost of ORT per child was Rs. 4.49 compared with Rs. 40.29 for intravenous fluids. Although these findings indicate DTUs are having a favorable impact on the rational management of diarrhea, health education campaigns aimed at promoting even more widespread use of ORT by mothers and health workers are needed.^ieng

Childhood morbidity in mobile hospital camps in Himachal Pradesh.

PIP: A systematic investigation of morbidity patterns was conducted in 1977- 80 among 2580 children under 12 years of age attending mobile hospital camps in 4 districts on India's Hamachal Pradesh. The children came from remote villages where socioeconomic and educational levels were low and environmental sanitation was rudimentary. There were 1301 cases of protein energy malnutrition in this group, 124 involving children 0-1 year of age, 514 in the 1-5-year age group, and 663 (51%) in the 5-12- year age group. At the time of examination, 287 of the children were infested with worms and 125 had diarrhea. These 3 conditions-- malnutrition, worm infestation, and diarrhea--were present in 32% of the village children surveyed. The most common form of morbidity was nutritional disorders (malnutrition, anemia, and vitamin deficiencies), affecting 70% of the children. The next most common condition was respiratory infection, affecting 35%. Other disorders affecting significant numbers of children were scabies, pyoderma, convulsions, mental retardation, rheumatic fever and congenital heart diseases, and renal diseases. Morbidity from conditions such as gastroenteritis, measles, and pneumonia was often accompanied by malnutrition. Thus, there is a need in this area for child health programs aimed at providing nutrition education as well as improving immunization coverage.^ieng