Antimicrobial susceptibility pattern of Burkholderia cepacia complex & Stenotrophomonas maltophilia from North India: Trend over a decade (2007-2016).

BACKGROUND & OBJECTIVES: With increased isolation of Burkholderia cepacia complex (Bcc) and Stenotrophomonas maltophilia from clinical specimens, knowledge of their antimicrobial susceptibility trend will aid in better patient management. This study provides a comprehensive picture of this trend over a decade. METHODS: A retrospective analysis of laboratory records over 10 years for antimicrobial susceptibility pattern of Bcc and S. maltophilia was carried out. The susceptibility pattern to commonly used antimicrobials was determined using disk diffusion and compared at the beginning, mid and end of the study period. RESULTS: Five hundred and thirty Bcc and 665 S. maltophilia isolated over the past 10 yr were included in the study. Over the years, susceptibility of Bcc for co-trimoxazole varied as 80, 70 and 89 per cent at the beginning, middle and end of the study, respectively. Susceptibility to tetracycline was 43 per cent at the beginning of the study and that to minocycline was 100 per cent mid-study and 74 per cent at the end. Susceptibility to ceftazidime varied as 83, 60 and 65 per cent, respectively, and to meropenem, increased during the first half of the study and decreased in the second half, as 60, 70 and 43 per cent, respectively. Bcc susceptibility to levofloxacin decreased from 84 (in 2014) to 76 per cent (in 2016). S. maltophilia susceptibility to co-trimoxazole varied as 90, 82 and 87 per cent, respectively, whereas that to levofloxacin was 80, 100 and 94 per cent, respectively, during the start, mid and end of the study. Susceptibility to minocycline decreased from 100 per cent mid-study to 96 per cent at the end. Susceptibility of S. maltophilia to ceftazidime increased from 24 (in 2012) to 37 per cent (in 2016). All variations among the three phases of the study were significant for all antimicrobials tested for both the organisms. INTERPRETATION & CONCLUSIONS: While Bcc showed increased resistance to ceftazidime, meropenem and minocycline, S. maltophilia maintained >80 per cent susceptibility to minocycline, levofloxacin and co-trimoxazole throughout the decade. By 2016, Bcc was most susceptible to co-trimoxazole, whereas S. maltophilia was most susceptible to minocycline and levofloxacin.

Geographical distribution of primary & secondary dengue cases in India - 2017: A cross-sectional multicentric study.

Background & objectives: Dengue virus infection is endemic in India with all the four serotypes of dengue virus in circulation. This study was aimed to determine the geographic distribution of the primary and secondary dengue cases in India. Methods: A multicentre cross-sectional study was conducted at Department of Health Research / Indian Council of Medical Research (DHR)/(ICMR) viral research and diagnostic laboratories (VRDLs) and selected ICMR institutes located in India. Only laboratory-confirmed dengue cases with date of onset of illness less than or equal to seven days were included between September and October 2017. Dengue NS1 antigen ELISA and anti-dengue IgM capture ELISA were used to diagnose dengue cases while anti-dengue IgG capture ELISA was used for identifying the secondary dengue cases. Results: Of the 1372 dengue cases, 897 (65%) were classified as primary dengue and 475 (35%) as secondary dengue cases. However, the proportion varied widely geographically, with Theni, Tamil Nadu; Tirupati, Andhra Pradesh and Udupi-Manipal, Karnataka reporting more than 65 per cent secondary dengue cases while Srinagar, Jammu and Kashmir reporting as low as 10 per cent of the same. The median age of primary dengue cases was 25 yr [interquartile range (IQR 17-35] while that of secondary dengue cases was 23 yr (IQR 13.5-34). Secondary dengue was around 50 per cent among the children belonging to the age group 6-10 yr while it ranged between 20-43 per cent among other age groups. Interpretation & conclusions: Our findings showed a wide geographical variation in the distribution of primary and secondary dengue cases in India. It would prove beneficial to include primary and secondary dengue differentiation protocol in the national dengue surveillance programme.

Emerging metronidazole resistance in Bacteroides spp. and its association with the nim gene: a study from North India.

OBJECTIVES: Bacteroides spp. are anaerobic resident intestinal flora but are also known to cause severe morbidity. They are resistant to a wide variety of antimicrobial agents, including metronidazole, which has been shown to be associated with specific nitroimidazole (nim) resistance genes. Metronidazole resistance is emerging worldwide, although presently it remains at ca. 5%. This study aimed to determine the metronidazole susceptibility and distribution of nim genes in Bacteroides spp. clinical isolates in India. The relationship among strains harbouring nim genes and their susceptibility to metronidazole was also analysed. METHODS: A total of 42 Bacteroides spp. clinical isolates were identified using an advanced MALDI-TOF system. Minimum inhibitory concentrations (MICs) for metronidazole were determined by the agar dilution method. Bacterial DNA was extracted and was subjected to nim gene PCR and the amplified PCR products were sequenced to determine the prevalent nim types. RESULTS: Bacteroides fragilis was the most common isolate (64%) among all Bacteroides spp. isolates. Among the total 42 clinical Bacteroides spp. isolates, 29 (69%) were susceptible and 13 (31%) were resistant to metronidazole by the agar dilution method. nim gene PCR performed on 38 isolates showed positivity in 20 isolates (53%), of which 12 had high metronidazole MICs (χ2 test, P<0.005). On sequencing, these nim genes were most closely related to nimE type. CONCLUSION: Resistance to metronidazole is consistently emerging worldwide. There is a significant association of the nim gene with metronidazole resistance. Periodic surveillance is needed to detect geographic and temporal trends in nim gene prevalence.

Evaluation of biomarkers: Galactomannan and 1,3-beta-D-glucan assay for the diagnosis of invasive fungal infections in immunocompromised patients from a tertiary care centre.

PURPOSE: Due to limitations of traditional microbiological techniques, standardised fungal biomarker tests such as Galactomannan Index (GMI) and 1,3-beta-D-glucan (BDG) are being preferred for diagnosis of invasive fungal infections (IFIs). These tests have been extensively used in developed countries but seldom in developing countries. The present study was performed to evaluate these tests for the diagnosis of IFIs in immunocompromised patients at an Indian tertiary care centre. MATERIALS AND METHODS: A retrospective hospital-based study was done in immunocompromised patients with clinical suspicion of IFI. The demographic, clinical, radiological and mycological details of the patients were recorded. The patients were categorised into proven, probable and no IFI (as per European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria). The sensitivity and specificity of BDG Fungitell and Platelia Aspergillus antigen assays was estimated. RESULTS: A total of 70 consecutive patients were included, of which 41 had IFI (10 proven and 31 probable) while 29 had no IFI. A significant association was found between IFI and the presence of a central venous line (P = 0.035) and history of intake of T-cell immunosuppressants (P = 0.001). Median BDG values (pg/ml) in patients with proven IFI, probable IFI and no IFI were 300 (range: 70-500), 165 (range: 53-500) and 45 (range: 31-500), respectively. The receiver operating characteristic (ROC) curve analysis for BDG revealed an area under the curve of 0.995, sensitivity: 97.4% and specificity: 96.6% for IFI diagnosis. The ROC curve analysis of GMI revealed an AUC of 0.75 and 90% patients with invasive aspergillosis (IA) had positive GMI. CONCLUSION: BDG has good sensitivity and specificity for distinguishing IFI from no IFIs and GMI may be used for diagnosing IA.

Hymenolepis diminuta infection in a child from urban area of North India: A rare case report.

Hymenolepis diminuta, also known as rat tapeworm, infects humans uncommonly. The diagnosis is based on the demonstration of characteristic eggs in the feces. We present a case report of H. diminuta infection in a 6-year-old female child from an urban area of India who presented with fever and seizures and also had complaints of intermittent abdominal pain, vomiting, and loss of appetite, without an apparent history of contact with rodents. The infection was treated with albendazole and showed clinical and parasitological cure. More awareness is required for a better understanding of epidemiology and transmission routes of this rare zoonosis.

Vertical transmission of Salmonella enterica serotype Paratyphi A leading to abortion.

Introduction. Enteric fever, caused by Salmonella enterica serotype Typhi (typhoid fever) or S. enterica serotype Paratyphi A, B or C (paratyphoid fever), is a major health problem in developing countries. Vertical transmission of Salmonella can cause miscarriage, still birth, preterm labour and neonatal sepsis. In the literature, many cases of vertical transmission of S. enterica Typhi from mother to foetus have been reported, but there are very limited studies showing vertical transmission of S. enterica Paratyphi. Case presentation. Here, we report a rare case of S. enterica serotype Paratyphi A infection in a pregnant woman resulting in a spontaneous miscarriage. S. enterica serotype Paratyphi A was isolated from placental membrane in culture. Conclusion. A high index of suspicion, along with timely cultures of relevant samples, like blood and stool, and timely initiation of antibiotic therapy in pregnancy could possibly save the lives of such foetuses.

Laboratory diagnosis of soil transmitted helminthiasis.

Soil-transmitted helminths (STHs) include, i.e., hookworms (Ancylostoma duodenale, Necator americanus), roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura) and Strongyloides stercoralis. Globally, around 1.5 billion people are infected with STHs. STHs contribute to significant impairment of mental and physical growth, especially in developing countries. Unfortunately, these infections mostly remain undiagnosed due to lack of trained personnel and appropriate technologies. Intermittent shedding of eggs or larvae further makes the diagnosis difficult. Thus, there is a dire need of rapid and accurate tests for the diagnosis of STHs. The diagnostic methods include conventional and molecular methods. Conventional methods include microscopy, culture, and egg counting. Serology has a role, especially in case of S. stercoralis where conventional methods have very poor sensitivities. The rapid, highly sensitive molecular techniques, particularly quantitative polymerase-chain reaction make it suitable for diagnosing STH over insensitive as well as labor-intensive conventional methods. Until now, molecular detection of STH was mainly restricted to the research setting, but now, there is recommendation of adopting molecular tests in the World Health Organization STH elimination programs. Thus, STH infections are important public health problems and should be appropriately diagnosed and managed to reduce the mortality and morbidity significantly.