Assessment of risk factors associated with drug-resistant tuberculosis in pulmonary tuberculosis patients.

INTRODUCTION: Tuberculosis remains a global health problem worldwide and the risk progression of Tuberculosis to Drug Resistant Tuberculosis is influenced by various factors. These include immunocompromised status, past history of tuberculosis, life style and nutritional level. Hence, identifying the population at risk of multidrug-resistant tuberculosis is essential and may help in developing appropriate case-finding strategies. Therefore, the present study was designed to study the contributing risk-factors associated with Drug resistant Tuberculosis. MATERIALS AND METHODS: In this prospective observational study, we assessed 189 Pulmonary tuberculosis diagnosed patients during the period of 2 years at government recognized tertiary care centers. Data was collected from all these patients checked to investigate risk factors associated with Drug resistant tuberculosis development by multivariant analysis. RESULTS: Of the 189 participants, 36 were diagnosed with drug resistant tuberculosis and 153 with drug sensitive tuberculosis. Factors associated with drug resistant tuberculosis include low-weight (OR 8.50; p = 0.0008430991), low-BMI (p = 0.0000527166), lower economic status (OR-2.1351; p = 0.048608696) and tobacco (OR-4.5192; p = 0.0023003189) were found clinically and statistically significant in development of drug resistant tuberculosis. Binary logistic regression was performed to ascertain the effects of various statistically significant factors. Drug resistant tuberculosis patients were 7.77 times more likely to be tobacco users than drug sensitive tuberculosis. CONCLUSIONS: Our study suggests that, there is a compelling and urgent need for increasing public awareness, initiating better nutrition and food programs, regular screening, and better management & control of MDR-TB.

Significance of Various Diagnostic Modalities in Detection of Tuberculosis in Cervical Lymphadenopathy: A Study of 200 Cases.

BACKGROUND: Extrapulmonary tuberculosis (EPTB) makes for 25% of all instances of tuberculosis (TB) patients. The enigmatic clinical presentation of EPTB makes identification difficult since it simulates other chronic conditions such as neoplastic and inflammatory disorders and could culminate in treatment that is either insufficient or not required. For an affirmative and confirmed diagnosis, a substantial level of suspicion is imperative. The paucibacillary feature of EPTB makes diagnosis extremely difficult and necessitates the use of many diagnostic methods to arrive at a precise diagnosis. In December 2010, the World Health Organization recommended using GeneXpert/cartridge-based nucleic acid amplification test (CBNAAT) for the initial assessment of suspected cases of EPTB. Furthermore, fine-needle aspiration cytology (FNAC), Ziehl-Neelsen (ZN) stain, and the CBNAAT have to be utilized to exclude other possible origins of granulomatous inflammation. The goal of the current investigation is to comprehend how FNAC and ZN stains relate to CBNAAT and their diagnostic value. METHODS: The evaluation included all suspected instances of tubercular lymphadenopathy, and adequate aspirates were obtained from the site of the enlarged cervical lymph nodes. Smears were made following FNAC and stained with ZN stain as well as hematoxylin and eosin stain. Simultaneously, CBNAAT and culture evaluations were conducted on the same aspirates. This cross-sectional study took place at a tertiary care center and encompassed 200 individuals with clinical manifestations of EPTB. RESULTS: There were 200 cases of suspected tubercular lymphadenitis (TBLN). According to the FNAC results, TBLN was detected in 71 (47.6%) of these 200 cases, followed by necrotizing lymphadenitis in 56 (37.5%), chronic caseating granulomatous lymphadenitis in 47 (31.5%), and reactive lymphadenitis in 26 (17.4%). They were correlated with CBNAAT results, which showed that all instances of tuberculous lymphadenitis, 85.71% of cases of necrotizing lymphadenitis, 55.32% of cases of chronic caseating granulomatous lymphadenitis, and 2 (7.69%) cases of reactive lymphadenitis were CBNAAT positive. CONCLUSION: CBNAAT should be utilized with FNAC and ZN staining to diagnose EPTB. The CBNAAT assay demonstrated a significant advantage in the identification of previously unidentified FNAC patients. Despite being a simple diagnostic tool, FNAC has a lower specificity and significantly lower precision than CBNAAT in correctly identifying cases of EPTB because it exhibits similar cytomorphological characteristics with lesions that are not associated with TB.

Commonly associated aerobic microbial pathogens and their antibiotic susceptibility profile in diabetic foot ulcers in tertiary care centre in Western Maharashtra.

PURPOSE: Diabetes mellitus (DM-II) is a metabolic disorder either due to reduced insulin production or reduced insulin sensitivity. Diabetic foot ulcer (DFU) is one of the most devastating complications of DM-II. This study was performed to assess commonly isolated micro-organisms and their anti-microbial sensitivity pattern in diabetic foot ulcers in a tertiary care centre in Western Maharashtra. METHODS: Adult patients with a known case of DM-II with foot lesions, suspected to be a Diabetic Foot Infections (DFIs) at the tertiary care hospital from Aug 2022 to Sept 2022 were included in the study. After obtaining informed written consent, pus sample was collected with sterile swab from lesion's base and submitted to Microbiology Laboratory for aerobic culture and sensitivity. RESULTS: Out of 56 enrolled patients, 47 (83.9%) patients tested positive for bacteriological growth and there was 'no growth' in 9 (16.07%) patients at the end of 48 h of aerobic incubation. There was male preponderance and patients were in age group of 35-85 years. The most commonly isolated micro-organisms were P. aeruginosa (17.8%), followed by S. aureus (14.2%), K. pneumonia and P. mirabilis (12.5% each). The resistance markers observed was ESBL producer, AmpC producer, MBL producer, Methicillin resistance and Inducible Clindamycin Resistance (ICR). CONCLUSION: Due to the injudicious use of antibiotics, antibiotic resistance has been increased in all types of soft tissue infections. The empirical formula for the treatment of DFIs should be decided for given geographical reasons according to antimicrobial susceptibility profile from particular geographical area or health care institute.

Seroprevalence of SARS-CoV-2 IgG in blood donors in a teaching institute from Western part of Maharashtra.

Introduction: COVID-19 is a disease caused by the severe acute respiratory syndrome coronavirus 2 that has appeared as a global pandemic in recent times. Currently, the transmission rate has slowed down significantly, but the definite pathological reason behind this is still unknown. Therefore, the prevalence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody must be studied to establish the relation between the rate of transmission and antibody presence. Materials and Methods: A clinical assessment was performed to evaluate the seroprevalence of SARS-CoV-2 Immunoglobulin G (IgG) antibodies among 299 healthy volunteers in the period of February to May 2021. Serum samples were analyzed using chemiluminescent microparticle immunoassay (CMIA) technology to detect the presence of IgG antibodies. Result: It was observed that 21% of the participants were seropositive, and 78% of the population was seronegative across the different genders. This confirmed that the generation of antibodies is independent of gender. Simultaneously, a t-test was performed that further suggested no statistical correlation between gender and seroprevalence. Moreover, a comprehensive analysis was performed to establish the relation between age and blood group with the seroprevalence. However, there was no statistical relationship found among these parameters. Conclusion: This study assisted in examining the underlying causes of high or low seroprevalence among healthy volunteers.

Lest we forget spinal tuberculosis (Potts's spine): Case series with unusual presentation.

Pott's disease, also known as TB spondylitis, is a very uncommon extrapulmonary infection caused by Mycobacterium tuberculosis. As its prevalence is not high it can easily be underdiagnosed. Magnetic resonance imaging (MRI), computed tomographic (CT) guided needle aspiration, or biopsy are known to be the best techniques for early histopathological diagnosis along with confirmation by microbiological results. Ziehl Neelson stain (ZN) can detect Mycobacterium infections when clinically suspected samples are adequate and optimally stained. No single method or simple guideline can diagnose spinal tuberculosis. Early diagnosis and prompt treatment are necessary to prevent permanent neurological disability and to minimize spinal deformity. We are reporting three cases of Potts disease which could have been easily missed if we would have relied on one single investigation.

Molecular Characterization Identifies Upstream Presence of IS Aba1 to OXA Carbapenemase Genes in Carbapenem-Resistant Acinetobacter baumannii.

Background Evaluating the expression pattern of oxacillinases (OXA) carbapenemases is essential to understand the prevalence and spread of carbapenem resistance Acinetobacter baumannii . Objectives The aim of the study is to evaluate the presence of OXA carbapenemase genes and IS Aba1 upstream to these genes in carbapenem-resistant A. baumannii clinical isolates. Materials and Methods A. baumannii isolated from clinical samples were phenotypically identified and antibiotics sensitivity was performed. Multiplex polymerase chain reaction (PCR) was used to detect OXA51-like gene, OXA carbapenemases genes (OXA-23-like, OXA-24-like, and OXA-58-like), and IS Aba1 in carbapenem-resistant isolates. Results Out of 55 Acinetobacter isolates, 54 were confirmed as A. baumannii by PCR. Bla OXA-23 -like gene was observed in 51 isolates of A. baumannii and none of the isolates showed the presence of bla OXA-24 -like and bla OXA-58 -like genes. Presence of IS Aba1 upstream to OXA-23-like gene, OXA-51-like gene, and both OXA-51-like/OXA-23-like genes was observed in 51, 7, and 4 A. baumannii isolates, respectively. Conclusion The genetic pattern of carbapenem-resistant A. baumannii isolated in this study was unique, which should be factored for clinical protocols to manage infections caused by emerging resistant strains of A. baumannii .

Role of GeneXpert MTB/RIF assay for the diagnosis of cervical lymph node tuberculosis and rifampicin resistance.

Objectives: Tuberculosis (TB) of lymph node (TB lymphadenitis) is one of the most common forms of extrapulmonary TB (EPTB) whose diagnosis is critically challenging. Although new diagnostic methods have been developed, especially in patients without a history of TB, the cervical tuberculous lymphadenitis diagnosis is still elusive. This study assessed the applicability of GeneXpert in early diagnosis of EPTB, especially cervical lymphadenopathy. Materials and Methods: The study was conducted in a tertiary care hospital from January 2018 to December 2020 at the department of microbiology. All the samples of cervical lymph node tissue and lymph node aspirate were followed as per the routine protocol for mycobacterial identification. The sample was divided into two parts: one was used for the new molecular-based GeneXpert MTB/RIF assay and the second one was tested by direct and concentrated acid-fast bacilli microscopy by Z-N staining and culture for the detection of MTB. Results: Among the 145 samples tested, the GeneXpert detected the DNA of MTB in 89 samples (61.37%), whereas the culture test was positive in 42 (28.93%) specimens. GeneXpert also detected 7 rifampicin resistance cases. GeneXpert sensitivity and specificity results were assessed according to culture results. The sensitivity and specificity of the GeneXpert assay were 85.71% and 48.54%, respectively. Conclusion: GeneXpert MTB/RIF should be used in conjunction with clinical presentation and other molecular investigation in nonrespiratory specimens.

Pencillium keratitis in an Immunocompetent Patient from Pune, Maharashtra, India.

The incidence of fungal keratitis is less common than bacterial and viral keratitis. However, it remains a diagnostic and therapeutic challenge. Delayed clinical diagnosis is common mainly because of lack of suspicion. Further slow growth of fungus increases the time for confirmed laboratory diagnosis. After accurate diagnosis, patient's management remains inadequate due to lack of availability of antifungal agents and its poor corneal penetration. Multitude of genera of molds and yeast have been identified in fungal keratitis. Due to their ubiquitous nature and easy isolation from the environment, their role in true pathogenesis is difficult to ascertain. Worldwide, incidence of fungal keratitis is rising at present. The predisposing factors comprises trauma, use of contact lenses and topical steroids. Filamentous fungi and dematiaceous fungi are the frequently encountered etiological agents of fungal keratitis. Dimorphic fungi are reported less frequently. Fungal keratitis tends to occur more frequently in young males and usually in winter and monsoon. Penicillium genera includes several species. By far Penicillium marneffei (P. marneffei) infection is most common, mainly associated with AIDS. A number of infections caused by species other than P. marneffei have been reported as well. Here we report a case of Penicillium keratitis in a young, HIV negative male farmer.

Tuberculous Otitis with Proteus mirabilis Co-Infection: An Unsuspected Presentation Encountered in Clinical Practice.

Tuberculosis, a contagious bacterial disease which is caused by Mycobacterium tuberculosis, primarily involves the lungs.Though Pulmonary tuberculosis (PTB) is the commonest clinical presentation, there is a need for alertness towards uncommon presentations which involve other organs. Tuberculous otitis media (TOM) is one such rare presentation seen in paediatric practice. It is characterized by painless otorrhoea which fails to respond to the routine antibacterial treatment. TOM usually occurs secondary to PTB. Here is a case of tuberculous otitis media with Proteus mirabilis co-infection, with no evidence of PTB. In the sample of ear discharge obtained from the patient, acid fast bacilli were demonstrated on direct microscopy after Ziehl-Neelsen staining. Culture done on Lowenstein-Jensen medium demonstrated slow-growing Mycobacterium. Bacteriological culture and identification helped in isolating Proteus mirabilis. PCR, followed by Line- Probe Assay for early identification and susceptibility testing to primary drugs, was done. Further, patient tested negative for the Mantoux test. Patient was enrolled in National Tuberculosis programme- RNTCP. This case emphasizes on one of the less common presentations of a common disease. A high clinical suspicion and laboratory confirmation are required for appropriate patient management.

The spectrum and aetiology of mycotic infections from a tertiary care hospital from Western part of India.

BACKGROUND: In the past few years, there has been an increase in infections caused by fungal aetiology. This is mainly due to increase in sizes of populations which are at risk. Also, fungi which were previously considered as non-pathogenic have been increasingly implicated. Hence, this study was taken up. AIM: To assess the magnitude of mycotic infections in this set up. To assess the spectrum of fungi which are involved in various infections. MATERIAL AND METHODS: Total 704 samples taken over two and half period were included. They consisted of various samples like sputum, blood, urine, sterile body fluids, corneal scrapings. These were processed by conventional mycological techniques. These included direct microscopy after Gram staining and KOH mount, culture on Sabouraud's dextrose agar (SDA), corn meal agar, brain heart infusion (BHI), brain heart infusion agar (BHIA) and others, as required. For non-albicans Candida, the automated Vitek 2 C system was used. Various moulds and yeasts were identified up to genus level and species level. RESULTS: Of 704 samples, 336 (48%) were positive for fungal culture. Of these, 244 isolates were yeast like fungi, 81 were moulds, 7 were yeasts and 4 were dimorphic. Among blood stream infections, non-albicans Candida were the commonest isolates. In the urine samples, C. albicans was the commonest isolate. From corneal scrapings, only moulds and dimorphic fungi were isolated. CONCLUSION: Incidence of non- albicans Candidal infections is increasing. Culture and identification of mycotic infections is essential for commencement of suitable antifungal therapy.

Primary splenic tubercular abscess in an immunocompromised patient-rapid diagnosis by line probe assay.

Diagnosing extra-pulmonary tuberculosis is a challenge that can confound even the most practiced clinicians as clinical manifestations are vague, non-specific and typical chest radiograph findings may not be evident till late in the disease. Conventional methods for mycobacteriological culture and drug susceptibility testing are slow and cumbersome. Novel technologies for rapid detection of Mycobacterium tuberculosis and its anti-TB drug resistance have therefore become a priority hence with the development of molecular line probe assays are most advanced. Herewith we are reporting a case of splenic tuberculosis in an immunocompromised patient for its rarity and to emphasis the fact that such patients can be diagnosed early for better treatment outcome to enhance the longevity if a health setup possesses all the modern diagnostic services.