Bronchial mucus plug mimicking fragmented Ascaris worm: An ambiguous case presentation.

With increasing travel and immunosuppression, parasitic lung and pleural diseases are increasingly been reported. The diagnosis in certain cases is very challenging because of nonspecific clinical and radiological features. We hereby present a case of a 60-year-old immunocompetent female complaining of difficulty in breathing for 4-5 days for which sputum sample along with the coughed-up fragment of the parasite under investigation was sent to the laboratory. All the blood parameters along with blood and sputum culture were within normal limits. Direct microscopy for sputum and multiple fecal samples did not yield any significant information. Chest X-ray was normal, whereas contrast-enhanced computed tomography scan changes were suggestive of fibrotic changes and mucoid impaction. The histopathological examination showed thick mucus content and no evidence of a parasitic infestation, worm, larva, or ova. So the differential diagnosis of the right lower lobe obstruction probably due to mucus plug was made, and the patient was referred to a pulmonologist for further follow-up. This case highlights the importance of common respiratory disorders characterized by mucus plugs and that some may mimic parasitic segments. Specific clinical, radiological, and pathologic features, microscopic examination, or serological testing can help to narrow the differential diagnosis of infective or noninfective causes and help the patients in early and accurate diagnosis and treatment and save them from unnecessary expensive and invasive investigations.

Cerebral phaeohyphomycosis due to Cladophialophora bantiana in an immunocompetent individual: A case report and brief review of literature.

BACKGROUND AND PURPOSE: Fungal infections of the central nervous system (CNS) are life-threatening conditions that are frequently misdiagnosed with bacterial and viral CNS infections. Cerebral phaeohyphomycosis is a cerebral infection caused by dematiaceous fungi, especially Cladophialophora bantiana. Very few cases of fungal CNS infection have been reported across the world. High clinical suspicion should be cast for the patients with brain abscess that do not respond to conventional antibiotic therapy. CASE REPORT: We report a case of a 21-year-old male presenting with headache, seizures and weakness in the limbs. Radiological examination revealed multiple brain abscesses. After surgical excision and laboratory evaluation, it was found to be caused by C. bantiana. The patient's outcome was good with surgical excision and voriconazole therapy. CONCLUSION: Brain abscess caused by C. bantiana is on rise, especially in immunocompromised groups. Thus, high clinical suspicion, accurate diagnosis and management are the fundamentals for good prognosis.

A pilot study for evaluation of knowledge and common practises of nursing staff regarding use of multidose injection vials and their microbial contamination rate in a super-specialty hospital.

CONTEXT: Multidose injection vials (MDVs) are prone to bacterial contamination, and their use has been reported to be a potential source of infections. AIMS: The aim of this study was to evaluate the knowledge and common practises of nursing staff regarding the use of MDVs and its microbial contamination rate. SETTINGS AND DESIGN: A pilot study was conducted in a super-specialty hospital from June to December 2016. SUBJECTS AND METHODS: Information about knowledge and common practises of 100 nursing staff posted in various Intensive Care Units (ICUs) with respect to the usage of single and MDVs, respectively, was obtained and assessed. About 40 in-use multidose injection vials containing some remnants were collected from different ICUs. The volume of 1 ml content of each of these vials was inoculated into a tube containing 15 ml thioglycolate broth and incubated at 37°C for 10 days. The broth was visually examined every day and subcultured onto blood, chocolate, and Sabouraud Dextrose agar plates on alternate days within 10 days or any time that the appearance seemed turbid. The microbial isolates thus obtained were identified using standard guidelines and recorded. STATISTICAL ANALYSIS USED: Descriptive statistics were used. RESULTS: The study group members had sufficient knowledge about various aspects of handling single and MDVs, respectively, such as hand hygiene, disinfection, checking of vial labels, and expiry date. Low hand hygiene compliance rate of 55% was observed in all ICUs visited during this study. The contamination rate of MDVs injection vials was 25% with Coagulase-negative Staphylococcus spp. being the most common isolate. CONCLUSIONS: The use of MDVs is associated with the risk of contamination and nosocomial outbreaks of life-threatening bloodstream infections. Healthcare professionals must strictly adhere to basic infection control practises as per standard guidelines to minimize the incidence of hospital-acquired infections.

Evaluation of Susceptibility of Glycopeptide-resistant and Glycopeptide-sensitive Enterococci to Commonly Used Biocides in a Super-speciality Hospital: A Pilot Study.

CONTEXT: Although existence of a probable association between glycopeptide and biocide resistance among enterococci has often been hypothesized, all studies conducted so far on this subject have been inconclusive. AIMS: The aim of this study was to explore the possibility of the existence of an association between glycopeptide resistance and reduced susceptibility to biocides among Enterococcus spp. SETTINGS AND DESIGN: This was a pilot study conducted in a super-speciality hospital situated in New Delhi, India, between June and November, 2015. PATIENTS AND METHODS: Fourteen isolates of Enterococcus spp. obtained from various clinical samples of inpatients were subjected to susceptibility testing by modified Kirby-Bauer disk diffusion method to the following antibiotics: ampicillin (30 µg), gentamicin (120 µg), linezolid (30 µg), teicoplanin (30 µg), and vancomycin (30 µg). Based on the preliminary glycopeptide susceptibility results, all the isolates were classified into glycopeptide-sensitive and glycopeptide-resistant groups, respectively. Isolates belonging to both of these groups were subjected to tube dilution method for determining minimum inhibitory concentration of three biocides, namely, sodium hypochlorite, povidone-iodine, and absolute ethanol, respectively. Minimum bactericidal concentration of these disinfectants was also determined as per standard guidelines. STATISTICAL ANALYSIS USED: Not applicable. RESULTS: More number of glycopeptide-sensitive strains exhibited reduced susceptibility to sodium hypochlorite than glycopeptide-resistant strains of enterococci. However, more number of glycopeptide-resistant isolates exhibited lower susceptibility to povidone-iodine than glycopeptide-sensitive isolates of enterococci. Both glycopeptide-sensitive and glycopeptide-resistant enterococci were equally susceptible to absolute ethanol. CONCLUSIONS: It seems that biocide resistance is an important issue and may have links with antibiotic resistance. This study points towards a possible association between glycopeptide resistance and reduced susceptibility to povidone iodine among enterococci. More studies should be conducted in order to further explore this supposedly enigmatic issue.

Time trends of seroepidemiology of hepatitis C virus and hepatitis B virus coinfection in human immunodeficiency virus-infected patients in a Super Specialty Hospital in New Delhi, India: 2012-2014.

BACKGROUND: Hepatitis viruses and human immunodeficiency virus (HIV) coinfection is a major cause of liver diseases worldwide. High prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Asia makes it important to understand HBV and HCV coinfection with HIV in this part of the globe. This study was done with the aim of assessing the time trends of seroepidemiology of HBV and HCV coinfection in HIV patients over the last 3 years. MATERIALS AND METHODS: Year wise retrospective analysis of data between January 2012 and December 2014 was done. RESULTS: The prevalence of HIV infection among 0-20 years and >60 years age group decreased over the last 3 years (2012-2014), 8.4%, 6.4%, and 3.1% and 3.6%, 3.8%, and 1.5%, respectively. While increasing prevalence was seen among 21-40 years age group, 57.8%, 60.2%, and 67.1%, respectively in 2012, 2013, and 2014. There was no significant relationship between age/gender and HBV/HCV seropositivity among HIV-positive patients. The risk of acquiring HBV infection was more in HIV-positive patients who were >60 years of age (odds ratio = 3.3182; 95% confidence interval: 0.3669-30.005). The prevalence of HCV seropositivity is less in HIV-positive patients as only one case was anti-HCV antibody positive in last 3 years who was a male patient in the age group 21-40 years. A declining trend was observed for HIV positive cases over 2012-2014 while no significant trend change is seen in HBV/HCV seropositivity among HIV patients from 2012 to 2104. CONCLUSION: It is recommended to screen HIV patients routinely for concurrent HBV/HCV infection as hepatotropic viruses with HIV increase the risk of liver mortalities.

Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associated urinary tract infection in a tertiary care hospital.

BACKGROUND AND AIMS: Catheter-associated urinary tract infection (CAUTI) is one of the most common health care acquired infection encountered in clinical practice. The present study was planned to assess the knowledge and attitude of health care providers regarding the indications for catheterization and methods of preventing CAUTI. METHODS: A prospective questionnaire-based survey was done from March 2011 to August 2011. A structured questionnaire comprising of 41 items related to demographic details of the respondents, their knowledge regarding indications for catheterization and methods of preventing CAUTI was given to 54 doctors and 105 nurses. The response was evaluated for statistical correlation using a computer software. RESULTS: The mean years of experience of the respondents in the health care setup was 6.8 years. Only 57% of the respondents could identify all the measures for prevention of CAUTI. The knowledge regarding the indication for catheterization though suboptimal was significantly better amongst the doctors as compared to nurses. CONCLUSION: The knowledge regarding indication and preventive measures was suboptimal in our study group. There is a tremendous scope of improvement in catheterization practices in our hospital and education induced intervention would be the most appropriate effort toward reducing the incidence of CAUTI.

Assessment of knowledge, attitude and practices among healthcare workers in a tertiary care hospital on needle stick injury.

PURPOSE: The study aims to assess healthcare workers' needle-stick injury (NSI) knowledge, attitudes and practices (KAP). DESIGN/METHODOLOGY/APPROACH: A cross-sectional study was conducted in a 600-bedded hospital throughout six months. The data were collected using an anonymous, self-reporting questionnaire. Participants were various healthcare workers (HCW) drawn through stratified random sampling and their knowledge, attitude and practice regarding NSI were assessed. FINDINGS: There is significant difference in the mean knowledge, attitude and practice scores among healthcare workers. Even though scores are better for doctors and nurses, practice scores were better for technical staff. Healthcare workers, who had better practice scores, had suffered fewer NSIs. Since this study is a cross-sectional, the population's NSI incidence could not be calculated. PRACTICAL IMPLICATIONS: This study emphasizes that applying knowledge to practice is required to prevent NSIs. Various recommendations to help prevent and deal with NSIs are made. ORIGINALITY/VALUE: This study analyses healthcare workers' NSI knowledge, attitude and practices, and also assesses their correlation with NSI incidence, which has not been done previously.

Post-operative sinus formation due to Mycobacterium abscessus: a case report.

SUMMARY: Mycobacterium abscessus is ubiquitously found rapidly growing mycobacteria. Although it is an uncommon pathogen, it has been known to cause cutaneous infection following inoculation, minor trauma or surgery. This communication reports an immuno-competent patient developing multiple sinuses due to Mycobacterium abscessus in the post- operative period.

Patient satisfaction survey of microbiological tests done in G.B. Pant Hospital.

PURPOSE: Measuring patient satisfaction plays an increasingly important role in the growing push toward healthcare provider accountability. This study seeks to evaluate G.B. Pant Hospital (a North Indian tertiary care centre) patient satisfaction with clinical laboratory services. DESIGN/METHODOLOGY/APPROACH: A total of 100 out- and in-patients were randomly selected and interviewed about microbiological services using a standard format, a method which can be easily used to compare patient satisfaction with laboratory services elsewhere. FINDINGS: Patients represented all age groups: females and males were balanced. Few were from poor socio-economic backgrounds. Patients do not have problems getting tests done, but the laboratory's inconvenient location caused dissatisfaction. Patients do not have problems communicating with staff, but medical terms are not understood by patients. Hospital cleanliness needs improving, especially toilets, which causes the most patient dissatisfaction. Hospital staff were deemed highly competent and judged to give excellent technical help to patients. The questionnaire's financial subscale shows 100 per cent satisfaction because all tests in the microbiology department are free. The overall satisfaction with services stood at 83 per cent. Satisfaction scores for G.B. Pant Hospital appear to be satisfactory. RESEARCH LIMITATIONS/IMPLICATIONS: This study does not compare patient satisfaction in two or more hospitals and findings may not be generalisable. PRACTICAL IMPLICATIONS: Patient satisfaction surveys are the best way to identify deficiencies and improve hospital services. Repeating studies at six monthly intervals is a useful managerial intervention aimed at delivering and maintaining quality healthcare. ORIGINALITY/VALUE: This laboratory satisfaction survey is the first of its kind for government hospitals in India. The survey revealed a positive feedback and helped to identify the areas of concern along with estimating the patient satisfaction scores. This is the best way to identify the areas of deficiencies and improving the services provided by the hospital. The authors feel that repeating such studies at a regular interval of six months would be a useful guide for the managerial interventions.

Candiduria in catheterized intensive care unit patients: emerging microbiological trends.

OBJECTIVES: Urinary tract infection (UTI) as a result of Candida spp. is becoming increasingly common in hospitalized setting. Clinicians face dilemma in differentiating colonization from true infection and whether to treat candiduria or not. The objective of the present study was to look into the significance of candiduria in catheterized patients admitted in the ICUs and perform microbiological characterization of yeasts to guide treatment protocols. MATERIALS AND METHODS: One hundred consecutive isolates of Candida spp. from the urine sample of 70 catheterized patients admitted in the ICU were collected and stocked for further characterization. A proforma was maintained containing demographic and clinical details. Blood cultures were obtained from all these 70 patients and processed. Species identification of yeasts was done on VITEK. RESULTS: Candiduria was more common at extremes of age. The mean duration of catheter days was 11.1 ± 6 days. Other associated risk factors such as diabetes mellitus and antibiotic usage were seen in 38% and 100% of our study group. Concomitant candidemia was seen in 4.3% of cases. Non-albicans Candida spp. (71.4%) emerged as the predominant pathogen causing nosocomial UTI. CONCLUSION: The present study reiterates the presence of candiduria in catheterized patients, especially in the presence of diabetes and antibiotic usage. Non-albicans Candida spp. are replacing Candida albicans as the predominant pathogen for nosocomial UTI. Hence, we believe that surveillance for nosocomial candiduria should be carried out in hospitalized patients.

Methicillin and Vancomycin Resistant S. aureus in Hospitalized Patients.

S. aureus is the major bacterial cause of skin, soft tissue and bone infections, and one of the commonest causes of healthcare-associated bacteremia. Hospital-associated methicillin-resistant S. aureus (MRSA) carriage is associated with an increased risk of infection, morbidity and mortality. Screening of high-risk patients at the time of hospital admission and decolonization has proved to be an important factor in an effort to reduce nosocomial transmission. The electronic database Pub Med was searched for all the articles on "Establishment of MRSA and the emergence of vancomycin-resistant S. aureus (VRSA)." The search included case reports, case series and reviews. All the articles were cross-referenced to search for any more available articles. A total of 88 references were obtained. The studies showed a steady increase in the number of vancomycin-intermediate and vancomycin-resistant S. aureus. Extensive use of vancomycin creates a selective pressure that favors the outgrowth of rare, vancomycin-resistant clones leading to heterogenous vancomycin intermediate S. aureus hVISA clones, and eventually, with continued exposure, to a uniform population of vancomycin-intermediate S. aureus (VISA) clones. However, the criteria for identifying hVISA strains have not been standardized, complicating any determination of their clinical significance and role in treatment failures. The spread of MRSA from the hospital to the community, coupled with the emergence of VISA and VRSA, has become major concern among healthcare providers. Infection-control measures, reliable laboratory screening for resistance, appropriate antibiotic prescribing practices and avoidance of blanket treatment can prevent long-term emergence of resistance.

Nosocomial blood-stream infections from extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumonia from GB Pant Hospital, New Delhi.

BACKGROUND: Nosocomial septicemia due to extended spectrum beta-(Beta)-lactamase (ESBL) producing Klebsiella pneumoniae and Escherichia coli are a therapeutic challenge due to resistance. Knowledge of disease burden and resistance patterns is required for proper and timely management. We report the prevalence and antimicrobial susceptibility of ESBL producing E. coli and K .pneumoniae from septicemia at a tertiary care hospital. METHODOLOGY: A total of 2,870 blood samples of suspected cases of septicemia were studied between January and December 2009. Antimicrobial susceptibility was determined by Kirby Bauer's disc diffusion method and MICs for imipenem, meropenem, and ertapenem were determined using the E-test. All isolates of E. coli and K. pneumoniae were tested for ESBL production by E-test method. RESULTS: Forty-one (70.7%) K. pneumoniae isolates and ten (41.7%) E. coli isolates were ESBL producers. Two (5%) of ESBL producing K. pneumoniae isolates, but no E. coli isolates, were resistant to carbapenems. In vitro, all ESBL producers were sensitive to tigecycline. CONCLUSION: Our data indicated that the prevalence of ESBL-producing E. coli and K. pneumonia strains isolated from blood cultures from hospitalized patients is high. ESBL-producing organisms were found to be more susceptible to meropenem than to imipenem and ertapenem. Tigecycline is active against all the ESBL or multidrug resistant (MDR) E. coli and Klebsiella spp. isolates.

Multidrug-resistant Gram-negative bacteria in postoperative infections.

Gram-negative bacteria are responsible in an important way in hospital-associated infections and their reported resistance to multiple antimicrobials is a matter of grave concern. In this study, Gram-negative bacteria isolated from clinical samples of postoperative infected patients were identified and their antibiotic susceptibility patterns determined. The prevalence of multidrug-resistant Gram-negative bacteria was 9.45% and the highest prevalence was seen in GI surgery department. Escherichia coli and klebsiella were the most common bacterial isolates. Amongst the 14 antibiotics tested, the percentage sensitivity against the multidrug-resistant Gram-negative isolates was highest for amikacin, meropenem, piperacillin + tazobactam and cefoperazone + sulbactam.

Hepatitis B and C virus infection in an urban slum of Northern India.

A community based cross sectional study was conducted in an urban slum amongst males to assess the magnitude of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections among males between 20-50 years of age. All of the 288 males who were contacted had agreed to participate in the study. However, the information could be collected from a total of 260 subjects, using a pretested, pre-coded schedule included sociodemographic characteristics. Serological tests were done for Hepatitis B and C. The data were analyzed using EPI-INFO 3.2.2. Proportion of persons tested serologically positive for Hepatitis B and C in the present study was observed to be 10.38% and 1.15%, respectively. Higher proportion for hepatitis B and C was observed amongst those Muslims, below 35 years of age, stay in the area for less than 5 years, Illiterates, unstable occupation, staying away from home and those with no history of blood transfusion or donation; however the difference was not statistically significant. There is a need to carry out more community based studies amongst such populations at risk in order to assess the true prevalence and risk factors for appropriate intervention.

Cryptococcal granulomas in an immunocompromised HIV-negative patient.

Disseminated cryptococcosis usually occurs in immunocompromised individuals with defective cell-mediated immunity, most commonly seen with HIV infection. We present a case of disseminated cryptococcosis in an HIV-negative male patient who presented with headache, fever, altered sensorium of short duration and multiple cutaneous lesions. An emergency CT scan of the head showed multiple intracranial and intraventricular granulomas. Routine laboratory investigations were within the normal range. A CSF examination revealed capsulated yeasts on India ink and a culture yielded cryptococcus neoformans. A cryptococcal antigen test by latex agglutination kit was positive. A biopsy revealed multiple capsulated yeasts cells in the cutaneous lesions, which were consistent with cryptococcus neoformans. The patient was successfully treated with Amphotericin B and Fluconazole with regression of cranial and cutaneous lesions.

Prevalence of clinical strains resistant to various beta-lactams in a tertiary care hospital in India.

The incidence of infection due to extended spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae has markedly increased in recent years. The traditional susceptibility methods lack sensitivity and/or specificity and this issue has prompted the search for an accurate test to detect the presence of ESBL. The present study included 300 bacterial strains and was undertaken to determine the prevalence of ESBL-producing strains. Here, compared three tests: a double disk synergy test (DDS), a three-dimensional test (3-D), and an inhibitor potentiated disk diffusion test (IPT); each test employed three different antibiotic discs, i.e., ceftazidime, ceftriaxone, and cefotaxime, in order to screen for ESBL strains. A strain was said to be an ESBL producer if it showed positive result(s) on any one of the three tests. The prevalence rate of ESBL in our hospital was 12.6% (38/300). IPT detected the most strains (34/38), followed by 3-D (23/38), and then DDS (15/38). The ceftriaxone disc was found to detect more ESBLs than either the ceftazidime or the cefotaxime disc.