Profile of yeasts isolated from urinary tracts of catheterized patients.

PURPOSE: Nosocomial fungal infections are important cause of morbidity and mortality in hospital patients. Urinary catheters have been held responsible to cause a large number of hospital acquired Urinary Tract Infections (UTIs). This study was undertaken to determine the incidence of nosocomial Candiduria associated with in dwelling urinary catheters, to characterize the species and assess their resistance to antifungal agents. MATERIALS & METHODS: Urine specimens from 510 catheterized patients were inoculated on Sabauraud Dextrose Agar; the species identification of Candida isolates was done by biochemical tests and antifungal susceptibility testing was done by disc diffusion method. RESULTS: Candida was isolated in 112 (21.96%) specimens. Of these, Candida albicans was commonly isolated in 50.89% followed by C. tropicalis, C. glabrata, C. krusei, C. parapsilosis, C. guillermondi and C. pseudotropicalis. Fluconazole resistance was encountered in some isolates. All C. glabrata and C. krusei were uniformly resistant to fluconazole and 8 of 16 C. tropicalis were also resistant to it. But only 7 of 57 isolates of C. albicans were resistant to it. Resistance to Nystatin was seen in 34 isolates. Similarly, emergence of resistance was also seen to Ketoconazole and Itraconazole in 24 of 112 isolates. Amphoterecin B resistance was exhibited by 3 C. albicans, 2 C. tropicalis, 1 C. glabrata and 1 C. krusei strain. C. albicans is an important nosocomial pathogen causing UTI in catheterized patients, nevertheless role of other species of Candida as emergent pathogens and resistance to antifungal drugs needs to be emphasized.

Pulmonary cryptosporidiosis in HIV negative, immunocompromised host.

Cryptosporidia are intestinal spore forming protozoa, which cause intracellular infections, predominantly in the epithelial cells of the intestine. Extra-intestinal infections with Cryptosporidium parvum have been rarely reported. However, a few reports of pulmonary cryptosporidiosis in HIV/AIDS cases have been mentioned in literature. In immunocompromised individuals who do not have HIV-related disease, Cryptosporidiosis has been rarely reported. We present a case of respiratory infection caused by C. parvum. The patient was a 10-year-old child with nephrotic syndrome and was receiving corticosteroids for 6 months. The child had history of low-grade fever, breathlessness and cough with expectoration of 3 months duration. The patient was nonreactive for HIV, and there was no evidence of primary immunodeficiency. Major serum immunoglobulins (IgG, IgA, and IgM) were in normal range. Simultaneous gastrointestinal involvement with C. parvum was observed.

Prevalence of methicillin-resistant Staphylococcus aureus nasopharyngeal carriage in children from urban community at Nagpur.

There has been a rise in the hospital acquired as well as the community acquired Methicillin Resistant Staphylococcus Aures (MRSA) infections in the recent years. We conducted a study to detect colonization rate of staphylococci in the nasopharynx in children and prevalence of MRSA nasopharyngeal carriage in pediatric population. The study included 1300 nasopharyngeal swabs collected from school going children between six to ten years age from Nagpur urban community and inoculated on blood agar for isolation of staphylococci. Isolates were subjected to antimicrobial testing and staphylococcus aureus isolates were also Phage typed at Maulana Azad Medical College, New Delhi. Staphylococci were isolated from nasopharynx of 138 (10.62%) children. Nasopharyngeal carriage of staphylococcus aureus was detected in 7.38% children. Methicillin Resistant Staphylococci constituted 4.16% of the Staphylococcus aureus strains. Colonization rate of MRSA in the pediatric population in the community was detected to be 0.31%. Methicillin Resistant Staphylococcus aureus nasopharyngeal carriage, though not at very high rate, is prevalent in the pediatric population in the community.

A rare case of human trypanosomiasis caused by Trypanosoma evansi.

Human trypanosoma infections like the ones seen in Africa and South America are unknown in India. The only exception in literature is of two documented cases of a self-limiting febrile illness, being attributed to Trypanosoma lewisi like parasites. We are reporting an unusual case of trypanosomiasis from the rural parts of Chandrapur district in Maharashtra. An adult male farmhand who used to practice veterinary medicine also, presented with history of febrile episodes on and off since five months and drowsiness before admission to this Institute. Though routine blood and other investigations were within normal limits, the peripheral smear showed a large number of trypanosomes which morphologically resembled the species Trypanosoma evansi, the aetiological agent of surra - a form of animal trypanosomiasis. A battery of assays covering the spectrum of parasitology, serology, and molecular biology confirmed the infecting parasite to be T. evansi. Failure to demonstrate the central nervous system (CNS) involvement, as evidenced by the absence of parasite in cerebrospinal fluid (CSF) advocated the use of suramin - the drug of choice in early stage African trypanosomiasis without any CNS involvement. Suramin achieved cure in our patient. The case is being reported because of its unique nature as the patient was not immunocompromised and showed infestation with a parasite which normally does not affect human beings.

Treatment and follow-up of the first case of human trypanosomiasis caused by Trypanosoma evansi in India.

The first reported human case of trypanosomiasis caused by Trypanosoma evansi was treated using suramin. Patient follow-up indicates that the drug and specific regimen used were well tolerated. Clinical, serological and parasitological investigations at 6 months indicate complete cure of the patient. Suramin should be considered in the treatment of other cases of human T. evansi infection, if they occur.

Modified cold Z-N staining for presumptive identification of Brucella.

Brucellosis is one of the most common zoonotic diseases in India. Growth of Brucella is slow and needs meticulous biochemical tests and antisera for confirmation of the isolates. In the present study modified cold ZN staining was tried on the broth cultures for early presumptive identification of Brucella growth. Blood cultures were attempted in 22 seropositive patients. In the five blood cultures positive for Brucella, acid-fast coccobacilli were seen in broth smears stained with modified cold ZN stain, thus providing presumptive identification of Brucella growth. Acid-fast bacteria were not seen in the broth smears of the remaining 17 broths negative for Brucella growth. The method is simple, reliable and reproducible and needs to be evaluated further on a larger sample.

Re-emergence of El Tor vibrio in outbreak of cholera in & around Nagpur.

Contrary to earlier outbreaks of cholera due to Vibrio cholerae O139 during 1993 and its reemergence in 1998 in and around Nagpur and only sporadic episodes thereafter for next couple of years, a large outbreak was encountered between June and October 2003. V. cholerae 01 El Tor were isolated in 198 cases, of which 152 were Ogawa, 3 Inaba, 4 Hikojima and 39 were non agglutinating (NAG) vibrios. No isolate of V. cholerae O139 was detected during the entire outbreak. The isolates were multi drug resistant to antibiotic susceptibility tests. This points to the resurgence of V. cholerae El Tor Ogawa causing outbreaks of cholera with a discernible increase in the incidence of multi drug resistant strains.

Epidemiological investigation of an outbreak of enteric fever in a village in Maharashtra.

Four hundred fifteen fever cases occurred in village Katkalamba, in Nanded district, Maharashtra during November-December, 1995. Explosive nature of the outbreak, non involvement of infants, significantly higher incidence rate in the age group 1-14 years and clustering of almost all cases in the users of a particular well indicated it to be a water borne outbreak. Laboratory investigations in selected cases confirmed it to be an outbreak of enteric fever. Chemical and microbiological examination of water samples from the suspected wells gave evidence of faecal contamination of water. Circumstances under which the contamination occurred and the outbreak spread are discussed.

Cholera epidemic in Solapur during July-August, 1988.

Of the 77 Vibrio cholerae isolated during July to September, 1988, 76 were El Tor vibrios serotype Ogawa, 68 belonging to T2 phage (eight strains untypable). Peak incidence was noted in the month of August, 1988. Haemolytic and non-haemolytic colony variants of El Tor V. cholerae were encountered. All strains showed resistance to one or more antibiotics. No fatality was reported during the epidemic. The epidemiological data collected over the past three years (1986-88) show that cholera is prevalent in the local environment.