Commencement and Monitoring: Microbiological Surveillance in Operation Theaters at a Tertiary Care Center in North India.

INTRODUCTION: Preserving sterility and safety in hospital operation theaters (OTs) is vital. We have implemented a comprehensive microbiological surveillance program for OTs, encompassing both commencement and ongoing monitoring. This study assesses the prevalence of microorganisms, identifies their types, and detects contamination on surfaces and in the air. METHODS: Commencement and monitoring samples were collected from October 2021 to July 2023, from nine OTs. OTs were cleaned with soap and water, disinfected, and fogged with quaternary ammonium compounds. After sealing the OTs overnight, samples were collected aseptically. Air was sampled using the settle plate method, and surfaces were swabbed. Six surfaces, namely, the floor, wall, table, light, anesthesia workstation, and door handle, were swabbed. Samples were transported immediately to the institution's microbiology laboratory. RESULTS: During OT commencement, 247 swabs from nine OTs yielded 19 (7.29%) positives for bacterial growth. These microorganisms were primarily non-pathogenic, including aerobic spore-forming bacilli and Micrococcus, with an average bioload of 9.5 colony-forming units (CFU)/m3 of air. During OT monitoring, swab positivity was 10.79% (23/213). The General Surgery OT and Obstetrics and Gynecology OT showed the highest bacterial growth (5/23). Surface sampling revealed prevalent methicillin-resistant coagulase-negative staphylococci (MRCoNS) (9/23), followed by methicillin-sensitive Staphylococcus aureus (MSSA) (4/23) and methicillin-sensitive coagulase-negative staphylococci (MSCoNS) and aerobic spore-forming bacilli (ASB) (3/10). The General Surgery, Obstetrics and Gynecology, and ENT OTs displayed elevated air bioloads of 53, 49, and 47 CFU/m3, respectively. CONCLUSION: In newly constructed non-operational OTs, non-pathogenic organisms prevailed. However, as the OTs became functional, pathogenic organisms became more prevalent. Sampling emphasized contamination in areas with high patient loads, such as General Surgery, Obstetrics and Gynecology, and ENT OTs. Notably, OT tables and OT walls exhibited higher pathogenic microorganism presence. By combining both initial commencement and ongoing monitoring, the institution has effectively managed the microbial environment within its OTs.

Actinomycetoma by Nocardia asteroides: A Case Report of a Unique Neglected Tropical Disease From North India.

Nocardial mycetoma is a neglected tropical disease reported worldwide, especially in tropical and subtropical regions. It is ubiquitous in nature and is a soil-borne, gram-positive, filamentous, aerobic bacteria with acute angle branching. Traumatic inoculation in endemic areas is the primary mode of infection of this debilitating disease. The clinical triad of tumefaction, draining sinus, and pus discharge with granules is very much characteristic and specific for clinching the diagnosis of mycetoma. However, the painless nature of the primary skin lesion often makes the patient present late to the clinician, often in the advanced stages of the disease. Here, we present a very intriguing case report of a young female patient who presented with a single neck nodule but was later diagnosed as a case of nocardial mycetoma. Timely diagnosis and initiation of therapy proved to be a boon for the patient with almost complete recovery within a few weeks in the form of healed skin lesions and insignificant scarring.

Investigating the Clinico-Demographic Characteristics of Dengue Fever and Its Seroprevalence at a Tertiary Care Hospital in Northern India.

Background and objective Dengue virus (DENV) is a major global health threat, causing over 50,000 deaths annually. The state of Uttar Pradesh (UP) in India faces significant challenges due to the increasing number of dengue cases detected. This study aimed to assess DENV seropositivity in the Raebareli district of UP, to offer crucial insights into the region's effective control and management strategies. Materials and methods This study, after obtaining approval from the ethics committee, analyzed blood samples of individuals suspected of having dengue at a teaching hospital in rural UP between January and December 2022. To determine the disease's seroprevalence, both dengue NS1 antigen ELISA and dengue IgM Microlisa were conducted. Furthermore, RT-PCR was performed on NS1-positive samples to confirm the serotypes. The collected data were analyzed using Epi Info 7.0. Results Of the 589 suspected dengue cases, 86 (14.60%) tested positive for dengue NS1 and/or IgM. Our findings showed that males (n=330, 56.03%) and adolescents and young adults (n=301, 51.1%) from rural areas (n=523, 88.4%) were predominantly affected. Cases peaked post-monsoon, and platelet levels were notably low in NS1-positive cases. Dengue serotype 2 (DEN-2) was found in all RT-PCR-positive samples. Our results revealed a dengue seroprevalence of 14.60% (n=86), which peaked in post-monsoon months. The higher incidence among males and young adults from rural areas attending the outpatient department highlights the importance of targeted interventions and community surveillance. RT-PCR confirmed the circulation of a single serotype in the region. Conclusions This study contributes crucial insights into dengue's epidemiology and clinical profile and its findings are all the more significant now as India prepares for phase 3 trials of a quadrivalent dengue-virus vaccine in 2024. Adolescent and young adult males have an increased likelihood of acquiring the virus, and this demographic can be prioritized for vaccine trials.

Identification of primary metabolites in fungal species of Trichophyton mentagrophyte and Trichophyton rubrum by NMR spectroscopy.

BACKGROUND: Superficial mycoses are fungal infections limited to the outermost layers of the skin and its appendages. The chief causative agents of these mycoses are dermatophytes and yeasts. The diagnosis of dermatophytosis can be made by direct mycological examination with potassium hydroxide (10%-30%) of biological material obtained from patients with suspected mycosis, providing results more rapid than fungal cultures, which may take days or weeks. This information, together with clinical history and laboratory diagnosis, ensures that the appropriate treatment is initiated promptly. However, false negative results are obtained in 5%-15%, by conventional methods of diagnosis of dermatophytosis. OBJECTIVES: To study the metabolic profiles of the commonly occurring dermatophytes by NMR spectroscopy. PATIENTS/MATERIALS: We have used 1D and 2D Nuclear Magnetic Resonance (NMR) experiments along with Human Metabolome Database (HMDB) and Chenomx database search for identification of primary metabolites in the methanol extract of two fungal species: Trichophyton mentagrophyte (T. mentagrophyte) and Trichophyton rubrum (T. rubrum). Both standard strains and representative number of clinical isolates of these two species were investigated. Further, metabolic profiles obtained were analysed using multivariate analysis. RESULTS: We have identified 23 metabolites in the T. mentagrophyte and another 23 metabolites in T. rubrum. Many important metabolites like trehalose, proline, mannitol, acetate, GABA and several other amino acids were detected, which provide the necessary components for fungal growth and metabolism. Altered metabolites were defined between Trichophyton mentagrophyte and T. rubrum strains. CONCLUSION: We have detected many metabolites in the two fungal species T. mentagrophyte and T. rubrum by using NMR spectroscopy. NMR spectroscopy provides a holistic snapshot of the metabolome of an organism. Key metabolic differences were identified between the two fungal strains. We need to perform more studies on metabolite profiling of the samples from these species for their rapid diagnosis and prompt treatment.

Phialemonium obovatum Infection of the Renal Allograft: Case Report and Review of the Literature.

In this case report, we describe the first case of Phialemonium obovatum infection involving the renal allograft in a recipient beyond 1 year after living renal transplant. The patient presented with a locally invasive mycetoma caused by this melanized fungus in the anterior abdominal wall, which extended during the hospital stay to involve the allograft. The fungus was identified by its characteristic micromorphological features present on potato dextrose agar and Sabourad dextrose agar and on subsequent slide cultures. The patient did not survive despite repeated surgical procedures, including partial allograft nephrectomy and broad-spectrum antifungal medications. Other cases of Phialemonium infections involving renal and stem cell transplant recipients are reviewed.