Increasing Prevalence of Escherichia coli and Klebsiella pneumoniae Producing CTX-M-Type Extended-Spectrum Beta-Lactamase, Carbapenemase, and NDM-1 in Patients from a Rural Community with Community Acquired Infections: A 3-Year Study.

BACKGROUND: Increasing prevalence of community-acquired infections (CAIs) due to Escherichia coli and Klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBL), especially the Cefotaxime-Munich (CTX-M) type, carbapenemase, and New Delhi metallo-ß-lactamase (NDM), has been reported globally posing a serious public health threat that has complicated treatment strategies for Gram-negative bacterial infections. While most of the reports in this regard are based on hospitalized patients from the urban community, there is a paucity of data in a rural community presenting with CAIs. MATERIALS AND METHODS: A total of 1275 strains of E. coli and K. pneumoniae isolated over a period of 3 years from patients with CAIs were subjected to the detection of ESBL by double-disc synergy test; carbapenemase by modified Hodge test; metallo-ß-lactamase by MIC test strip metallo-ß-lactamase (MBL); and bla TEM, bla SHV, bla CTX-M, and bla NDM genes by polymerase chain reaction. RESULTS: Among 1275 E. coli and K. pneumoniae isolated during the study period, 773 (60.6%), 102 (8%), and 28 (2.2%) isolates were detected as ESBL, carbapenemase and MBL producers, respectively. Of the 773 ESBL producers, 635 (82.1%) were found to harbor bla CTX-M genes, and of the 102 carbapenemase producers, 12 (11.8%) were found to harbor bla NDM genes. Gene sequencing of all the 12 NDM-positive isolates revealed bla NDM-1 genes. Antibiotic resistance pattern of the ESBL-positive isolates revealed a high degree of co-resistance to noncephalosporin antibiotics such as amoxyclav, co-trimoxazole, chloramphenicol, and fluoroquinolones. CONCLUSION: The present study showed the increasing the prevalence of ESBL including CTX-M variety, carbapenemase production by E. coli and K. pneumoniae isolates, and spread of NDM-1 in the patients from the rural community of North India.

Role of HCV coinfection towards disease progression and survival in HIV-1 infected children: a follow-up study of 10 years.

The present study was taken up to evaluate the pattern of disease progression and survival in a group of HIV-1 positive children, coinfected with HCV infection (n=25) in comparison to those without such coinfection (n=23). There was a significant negative correlation between the rate of decline of the CD4 + T cell percentage and the duration of the AIDS-free interval in most (80.0 per cent) of the HCV seropositive children showing such decline (r=-0.588; p=0.005). The HCV seropositive children had twofold higher risk of progression to development of AIDS than HCV seronegatives (RR=2.51; 95 per cent CI:1.34-4.69; p=0.004). There was a significant negative correlation between the rate of decline of CD4 + T cell percentage and overall survival duration for HCV seropositive group (r=-0.609; p=0.003). Moreover, children coinfected with HCV had more than twofold higher risks of death than those without HCV (RR=2.39; 95 per cent CI:1.17-4.89; p<0.01). It appears that HCV infection may be an important contributor to the rapid disease progression and increase in mortality in HCV-HIV-1 coinfected children of thalassemia major.

Malaria, leprosy and dapsone.

Although the preventive action of dapsone against P. falciparum malaria was known for many years, there was no report about the incidence of P. falciparum malaria in leprosy patients treated with dapsone, especially from areas of Southeast Asia where both leprosy and malaria are endemic. Therefore, two clinic-based malaria surveys were undertaken at a gap of 12 years, comprising 506 lepromatous leprosy patients and 499 febrile nonleprosy control subjects. Both the surveys showed that the lepromatous patients treated with MDT had only P. vivax malaria (incidence comparable to the febrile nonleprosy controls) with complete freedom from P. falciparum. On the contrary, control sujects not taking any-leprosy drugs and staying with the leprosy patients at the same beggars' home, had both P. vivax and P. falciparum malaria. It is postulated that dapsone provided protection against P. falciparum among leprosy patients.