Seroprevalence of syphilis by VDRL test and biological false positive reactions in different patient populations: Is it alarming? Our experience from a tertiary care center in India.

INTRODUCTION: Many centers for sexually transmitted infections in India perform only a single screening assay for diagnosis of syphilis which may yield biological false positive (BFP) reactions. AIMS AND OBJECTIVE: The aim of this study was to determine the true picture of seroprevalence of syphilis and BFP reactions in different patient groups. MATERIALS AND METHODS: A total of 57,308 serial serum samples obtained over a period of 5 years from different patient groups were screened by venereal disease research laboratory (VDRL) test both qualitatively and quantitatively. VDRL reactive sera were confirmed by Treponema pallidum hemagglutination (TPHA) test. RESULTS: The overall seroprevalence of syphilis by VDRL test was 1.27%, and BFP rate in test population was 0.14%. The rate of BFP reactions among total tested male (0.44%) and female (0.1%) patients differs significantly. Out of 733 VDRL reactive samples, 81 were BFP, i.e., BFP reaction is occurring at a frequency of 11% of the total VDRL reactive samples (ratio of 8:1 for true positives/BFP). Similarly, among antenatal cases, almost 24% of the total VDRL reactive samples were BFP, or for every 116 true positives, there were 37 (almost one-third) BFP. CONCLUSION: Although the overall seroprevalence of syphilis is low; the frequency of occurrence of BFP reactions is quite alarming. Hence, treponemal test must be used for confirmation of VDRL reactive sera.

Changing prevalence and antibiotic drug resistance pattern of pathogens seen in community-acquired pediatric urinary tract infections at a tertiary care hospital of North India.

AIMS AND OBJECTIVES: The aim and objective of this study was to assess the temporal changes in the microbiological profiles and antimicrobial resistance patterns of uropathogens in pediatric community-acquired UTI. MATERIALS AND METHODS: This is a retrospective analysis of data collected over a Scattered period of 5 years. The baseline data collected were from January to December 2009, and the second period considered for comparison was from January to December 2014. Urine specimens from children (<17 years) suspected of UTI were cultured by a semi-quantitative method on cysteine lactose electrolyte-deficient medium. Antibiotic sensitivity was put up by Kirby-Bauer disc diffusion method as per the Clinical and Laboratory Standard Institute guidelines. RESULTS: In the year 2009, 340 of 2104 (16.15%) urine specimens yielded significant colony count, whereas in 2014, it was 407 of 2212 (18.39%) (P = 0.051). Escherichia coli was the predominant pathogen and was significantly more prevalent in girls than in boys (P < 0.0001) during both periods. There was a significant overall increase in resistance to ampicillin (from 40.29% to 58.72%), amoxyclav (from 26.17% to 40.54%), nitrofurantoin (from 28.82% to 39.06%), and norfloxacin (from 30% to 41.42%). However, the maximum increase in the resistance was noted for co-trimoxazole from 35.58% in 2009 to 63.39% in 2014 (P = 0.0000058). The prevalence of extended-spectrum beta-lactamases (ESBLs) has also significantly increased from 21.7% to 33.16% (P = 0.0045). CONCLUSION: Although E. coli remains the prime pathogen in pediatric UTI, the prevalence of resistance has dramatically increased over the 5-year study period. Our study highlights the emergence of community-acquired ESBL-producing uropathogens in children proclaiming treatment challenges.

Fosfomycin for the treatment of drug-resistant urinary tract infections: potential of an old drug not explored fully.

INTRODUCTION: Increased emergence of bacterial resistance and the limited options of novel antimicrobial agents have necessitated the reintroduction of some old antimicrobial agents. One such drug is fosfomycin, but its potential has not been explored fully, especially in India. AIMS AND OBJECTIVES: To analyze the in vitro activity of fosfomycin, against the urinary isolates and to compare it with in vitro activity of other orally administered antimicrobial agents. MATERIALS AND METHODS: This was a prospective observational study conducted between July 2014 and June 2016. All consecutive, non-duplicate and clinically significant urinary isolates obtained from patients of all ages and both genders, diagnosed to have UTI, were included. Patients already on antibiotic therapy were excluded. Urine culture was performed by semiquantitative method on cysteine lactose electrolyte-deficient medium and the isolates obtained in significant count were subjected to antimicrobial sensitivity testing by the Kirby Bauer disk diffusion method as per CLSI guidelines. RESULTS: A total of 3947 non-repeating urinary isolates were included in the study, of which 2684 (68%) isolates originated from adult outpatients and remaining 1236 (32%) isolates from pediatric patients. Of these 2783 isolates were from enterobacteriaceae family. Out of these 2730 (98.1%) were sensitive to fosfomycin. Most [375 of 385 (97.4%)] Pseudomonas spp were also susceptible to fosfomycin. A majority of ESBL- (96.5%) and MBL (91.9%)-producing isolates were also susceptible to fosfomycin and so were of Gram-positive isolates [698/707 (96%)] and MRSA [61/69 (88.4%)] were susceptible to fosfomycin. CONCLUSIONS: Fosfomycin showed an excellent in vitro activity against all urinary pathogens, including the Gram-positive or Gram-negative, ESBL and MBL producers. Fosfomycin should be considered as a highly effective alternative in treatment UTIs in both adults and pediatric patients.

A Comparative Analysis of Polymerase Chain Reaction and Direct Fluorescent Antibody Test for Diagnosis of Genital Herpes.

OBJECTIVE: To compare laboratory tests that can simultaneously detect and type herpes simplex virus (HSV) directly from the genital ulcer specimens in clinically suspected cases of genital herpes. MATERIALS AND METHODS: A study was conducted over 10 months and 44 adult male and female patients clinically suspected with genital herpes were recruited. Genital ulcer swab specimens were subjected to glycoprotein-G gene-based conventional polymerase chain reaction (PCR) and commercially available direct fluorescent antibody (DFA) test and the results were compared. RESULTS: PCR for HSV was positive in 82% (36/44) cases. DFA was positive in 68.2% (30/44) cases. There was 100% agreement between HSV types detected by DFA and PCR. The strength of agreement between the results was better in primary genital herpes than recurrent cases. CONCLUSION: PCR was found to be better in the detection of HSV in recurrent genital herpes patients. It is a better modality, especially when genital herpes clinically presents with ulcerative or crusted lesions, and is also a cheaper alternative as compared to DFA.

Role of type-specific herpes simplex virus-1 and 2 serology as a diagnostic modality in patients with clinically suspected genital herpes: A comparative study in Indian population from a tertiary care hospital.

INTRODUCTION: Type-specific serology (TSS) test for herpes simplex virus (HSV) have been used as a research tool in seroepidemiological studies for some years. However, TSS as a diagnostic modality for diagnosis of current episode of genital herpes is not well documented. AIMS AND OBJECTIVES: To measure the seroprevalence of type-specific HSV Type 1 (HSV-1) and Type 2 (HSV-2) IgG antibodies in cases provisionally diagnosed as primary and recurrent genital herpes and to evaluate the role of TSS as a diagnostic modality for diagnosis of genital herpes versus polymerase chain reaction (PCR). MATERIALS AND METHODS: A cross-sectional study was performed over a period of 10 months in which 44 adult patients with clinically suspected genital herpes were recruited. An in-house glycoprotein G gene base PCR was performed directly from the genital lesion specimen for simultaneous detection and typing of HSV. TSS was performed to detect IgG antibody against HSV-1 and 2 in all patients using commercially available kits, and the results were compared. RESULTS: Seroprevalence of HSV-1 IgG was 43% among primary and 65% among recurrent genital herpes cases (P = 0.22). Whereas that of HSV-2 IgG was found to be 14% and 83% in respective patient group (P = 0.0001). When compared to PCR results HSV-1 IgG detection in both primary and recurrent genital herpes diagnosis had poor specificity, positive predictive value, and sensitivity. Whereas, HSV-2 serology had a sensitivity of 13.33% and 73.33% in primary and recurrent genital herpes and specificity of 83.33% and 85.71%, respectively. CONCLUSION: HSV-2 IgG detection helps in strengthening the diagnosis of recurrent HSV-2 disease, whereas the absence of HSV-2 IgG antibody helps in excluding genital herpes as a likely cause of recurrent genital ulceration. However, detection of HSV-1 IgG antibody may not be useful for diagnosis in patients of genital ulcer disease.