The reliability and rapidity of the coagglutination technic and its comparison with precipitin technic in the grouping of streptococci.

Three methods of the grouping of 170 strains of beta-hemolytic streptococci belonging to Groups A, B, C, F, and G by capillary and agar-gel precipitation using Lancefield extract and by coagglutination of antibody-coated protein A-containing staphylococci were compared. Capillary and agar-gel precipitin technics correctly grouped all 170 strains, with no cross-reaction. One hundred sixty-nine out of the 170 strains were also correctly grouped by the coagglutination technic, and the one strain with a cross-reaction was correctly grouped after blood--agar subculture. Although 20 of the 170 strains showed minor cross-reactions by the coagglutination technic, the specific groups were easily and unquestionably detected, and the minor cross-reactions were easily overcome. A rapid method of grouping by coagglutination technic using 4--6-hour broth culture, done on 75 strains, showed that 73 strains could be correctly grouped by the rapid method and two after overnight incubation. Thus, the coagglutination technic of grouping was found to be easy, reliable, and economical, and could be adopted in any routine diagnostic laboratory as a rapid grouping procedure.

Development of a coagglutination (COA) technic to detect Candida antigenemia. I. COA versus Candida isolation.

A coagglutination (COA) test to detect Candida antigenemia was developed using locally produced Candida antiserum and COA reagent. All 68 controls had normal results. Two patient groups were included in this study. In Group 1, consisting of eight patients, with definite systemic or deep candidiasis proved by repeat Candida isolation, COA detected antigenemia in 100% as against 50% by counterimmunoelectrophoresis (CIE). In Group 2, 9 of 19 patients had respiratory infection; 4 patients revealed antigenemia by COA, 2 of whom had no Candida isolation. In these 2 patients therapy was initiated based on COA results. Of another nine patients with hematologic and malignant diseases, five (56%) revealed antigenemia by COA, three of whom had no Candida isolation; two died and one was discharged against advice. Transient antigenemia was detected by COA in a single patient with ulcerative colitis with Candida isolation. Thus, the COA test was found to be rapid, sensitive, and specific for the detection of Candida antigenemia. Furthermore, it had early diagnostic (seven days) as well as prognostic value, as revealed by response to therapy and decrease in COA titer. Being highly cost effective, this test is recommended as a simple test within the reach of any routine diagnostic laboratory.

Acremonium recifei as an agent of mycetoma in India.

Acremonium recifei was identified as the causal agent in a case of white grain eumycotic mycetoma of the hand which occurred in South India. The identification was based on the structure of the granules in tissue and on the morphological characteristics of the culture obtained from the granules. This case represents the first documented instance in which A. recifei has been found outside of Latin America.

Brain abscess and other protean manifestations of actinomycosis.

Reports on human actinomycosis documented by culture have been infrequent, particularly from India. The present paper reports 12 cases of actinomycosis confirmed by culture. These include two unusual cases of actinomycosis of the brain with no granules in the pus, two pulmonary cases, one renal, one abdominal, and six cervico-facial. The lethal outcome with organ involvement, and the chronicity in some cases, warrant early etiologic confirmation and prompt treatment.

First case of subcutaneous zygomycosis caused by Saksenaea vasiformis in India.

The first case of subcutaneous zygomycotic infection caused by Saksenaea vasiformis in a rice mill worker from India is described. The infection, confined to the man's left foot, showed multiple draining sinuses, inflammation, and intermittent low-grade fever following a crushing injury when a log fell on his foot. Histopathologic examination of two biopsy specimens, taken at 3-wk intervals, revealed the presence of broad, sparsely septate, branched, hyaline hyphae characteristic of a zygomycete. When they were grown on a nutritionally deficient medium, two cultures isolated from the biopsied tissues formed numerous, vase-shaped sporangia typical of S. vasiformis. Necrosis of the affected area led to amputation of the fore part of the foot. A split thickness graft was well accepted, and treatment with potassium iodide, following the graft, cured the infection.

Use of enzymes in typing group A beta-haemolytic streptococci.

A series of 698 strains of group A beta-haemolytic streptococci (GAS) isolated from children with streptococcal pyoderma was tested for production of serum opacity factor (OF) and nicotinamide adenine dinucleotide glycohydrolase (NADase). OF was produced by 37% of strains and 40% produced NADase. Classification based on various combinations of OF and NADase reactions showed that 58% belonged to enzyme group el and 34% to e2. Correlation with T and M types showed the possible use of this means of classification as an epidemiological marker for GAS. The specificity of such a system in the further classification of various T types of GAS in epidemiological studies, in the light of antigenic variation among M types, is described.

Coagglutination (COA) test for the rapid diagnosis of cryptococcal meningitis.

Cryptococcus coagglutination (COA) test reagent was prepared locally and showed no cross reactions with different species of bacteria or yeasts or with 75 control sera including 25 that gave positive results for RA factor. We used the COA test to detect cryptococcus antigen in the CSF and we could confirm the diagnosis of 11 out of 115 suspected cases of fungal meningitis; the titre varied from 4 to 128. A four-fold rise in titre confirmed the diagnostic value and a steady fall in titre in three patients on therapy indicated the prognostic value of the test. The earliest confirmation was in a renal transplant patient on the eighth day after onset of symptoms. The COA test was negative with the CSF of 118 patients with chronic meningitis. Cryptococcal colony forming units (cfu) in CSF varied from 100 to greater than 100,000/ml and correlated well with microscopy and with the COA antigen titre in CSF. Four out of the 11 patients who had cryptococcaemia, had 50,000-100,000 cfu/ml in the CSF. Cryptococcus antigen was detected by COA in the serum of all 11 patients, even in those with only 100 cfu/ml in CSF. In the three post-renal transplant patients, who were being monitored regularly, the diagnosis was made early and all three recovered on antifungal therapy with no relapse to date (1-2 years). All the others, including the two primary CNS infections, succumbed to the disease because they presented late for diagnosis and therapy. The cryptococcus COA test is a simple and specific test that can be used as a rapid test to confirm early diagnosis and permit prompt therapy, which should improve the prognosis in CNS and other forms of systemic cryptococcosis. Moreover, it is reproducible and cost-effective, particularly in countries where the latex and other expensive test reagents are not generally available.

Streptococcal antibodies and complement components in tropical post-streptococcal glomerulonephritis.

Anti-deoxyribonuclease "B' was elevated in 94.9% of 59 cases of post-streptococcal glomerulonephritis studied, whereas ASO was elevated only in 54.4% of cases showing that the ADNB titre is a more sensitive indicator of antecedent streptococcal infection than ASO, in tropical countries with a high prevalence of pyoderma. Serum C3c (beta 1A) levels were significantly decreased, especially in the early phase of the illness and returned to normal with remission. C4 levels were decreased only in the early phase of the illness, suggesting involvement of the alternate pathway subsequent to classical pathway activation.

Leptospirosis--clinical spectrum and correlation with seven simple laboratory tests for early diagnosis in the Third World.

Twenty-four patients who were clinically suspected of having leptospirosis were subjected to 7 simple commonly available laboratory tests. The 21 patients who had 3 or more positive tests were confirmed serologically to have leptospirosis. The high frequency of acute abdominal pain (71.4%) as a major presenting symptom and the laboratory findings of raised serum amylase levels in a high percentage of patients (84.2%) were especially noteworthy.

Aeromonas species in human septicaemia & diarrhoea.

An increase was observed in the isolation of Aeromonas sp. from clinical specimens, especially faeces, from patients with diarrhoeal disease and blood cultures from patients with suspected septicaemias. The isolation rate from diarrhoeal patients was 0.2 per cent in 1978-79 and this increased to 5.0 per cent in 1986-87. It is noteworthy that 13 patients of septicaemia due to Aeromonas species were encountered, predominantly in adults with lowered resistance due to underlying disease states including chronic diseases of the liver and kidney.

Long-term preservation of streptococci.

Strains of 12 T types of group A streptococci preserved by sand desiccation and stored at 4 degrees to 10 degrees C were regularly sub-cultured to check their viability. For this, streptococci coated onto sand particles mixed with sterile sheep blood were inoculated into Todd-Hewitt broth with added blood and incubated for 24 to 48 h. Checking for viability every six months showed that group A streptococci could be preserved by this method for 21 yr. Our study shows that sand desiccation is a convenient and cheap method for the long-term preservation of streptococci in laboratories where other methods of preservation are not feasible on a regular basis.

Speciation of viridans streptococci & their significance in human infections.

Sixty strains of viridans streptococci recovered, from various infections, encountered in a large referral Hospital in Tamil Nadu (south India) from December 1983 to May 1985 were characterised by conventional tests. Of these, 57 (95%) belonged to four species viz., Sanguis II, Mitis, Intermedius and Constellatus. Of the 40 strains that were assessed for their clinical significance, 23 (57.5%) were found to be either significant or of suggestive significance. The study suggested viridans streptococci are not particularly virulent pathogens. But local/systemic factors were found to predispose the subjects to this infection.

Transferable trimethoprim resistance of shigellae encountered in Vellore (south India).

Shigella flexneri and Sh. shigae which are the two most common shigellae encountered in Vellore (south India) were found to exhibit resistance to trimethoprim and trimethoprim-sulphamethoxazole. Eighty four per cent of this was high level resistance. Transfer studies conducted with these strains indicated that this high level resistance is plasmid mediated.

Aspergillus terreus, an uncommon fungus causing aortic root abscess and pseudoaneurysm.

Aspergillus Terreus is a rare fungus which can cause opportunistic infection in humans. A fifteen year old girl had undergone open aortic valvotomy for aortic stenosis and post-stenotic dilatation of the ascending aorta. She was discharged after an uneventful post-operative period. She was reoperated later for para-aortic abscess. The pus on culture yielded pure growth of Aspergillus Terreus from multiple media. To our knowledge, this is the first report from India of Aspergillus Terreus causing human infection. Clinical awareness of the rising importance of fungal infections is alerted.

Central venous catheter related infections in a tertiary care hospital.

Intravascular catheters are increasingly important causes of nosocomial infections. Catheter related complications range from local exit site or tunnel infections to frank bacteremias. A semiquantitative method of culture of central venous catheters (CVC) was done in our hospital from January to December 1996. A total of 119 catheter tips sent to the Microbiology Department were cultured and 11 (9.24%) showed significant growth with associated blood stream infection. 14 (11.76%) of the CVCs showed scanty or less than 15 colonies in roll or contents and there was no associated blood stream infection. 7 (5.88%) showed moderate to heavy growth in roll and contents and there was no blood stream infection. The age groups ranged from 2 months to 66 years. The results of the study indicate that Gram negative organisms formed the predominant isolates. Gram negative isolates included Klebsiella species, Enterobacter species, E. coli species, Serratia and non-fermenting Gram negative bacilli. Coagulase negative staphylococcus which is often believed to be an important pathogen was not associated with bacteremia or septicemia in our hospital, during this study period. Considering the fact that 1553 operations were performed during the study period, the infection rate through CVC's would work out to a negligible 0.71%.

Cutaneous lymphatic sporotrichosis.

The first case of cutaneous lymphatic sporotrichosis from Nagaland and a case of cutaneous sporotrichosis from Kerala who had acquired infection from Assam are reported. The diagnosis in both cases were established by isolating Sporothrix schenckii from multiple cutaneous lesions. The dimorphic nature of fungus was established in vitro by demonstrating the mycelial phase at 25-30 degrees C and yeast phase at 37 degrees C and pathogenicity to white mice. Both the patients were successfully treated with oral administration of potassium iodide for 3 months.

Non 01 Vibrio cholerae in intestinal and extra intestinal infections in Vellore, S. India.

Non 01 V.cholerae is known to cause gastroenteritis and extra intestinal manifestations, including septicemia. We report here our isolation of non 01 V.cholerae from various clinical specimens. Although most of the isolates are from faeces samples from patients with diarrhoea, we have three isolates from blood culture in patients with underlying liver disease. The highest incidence occurred in 1982-1983 and 1987 and 1988.

Fallacies in the interpretation of Paul-Bunnel Davidsohn differential test.

Serological findings in five cases where Paul-Bunnel Davidsohn (PBD) test results were misleading, are presented. Three patients' with Chronic renal disorder and positive PBD test had specific serology results, signifying Cyto Megalo Virus infection. A fourth patient with Hepatitis B Virus infection also had positive PBD test. Forssman type of antibody response was demonstrable in a boy with recent Epstein-Barr virus infection and high Cyto Megalo Virus antibody titres.