Diabetes mellitus and human immunodeficiency virus (HIV) infection in people with tuberculosis in Odisha, India.

BACKGROUND: Modelling studies have indicated that approximately 20% of all tuberculosis (TB) cases may suffer from diabetes mellitus (DM). DM increases the risk of developing active TB disease by 2-3 times. People living with HIV (PLHIV) are more likely to develop TB disease, and TB is a leading cause of hospitalization and death among PLHIV. Despite the substantial burden of DM and HIV in India, few studies have evaluated the prevalence of DM and HIV among active cases of TB, and its impact on the treatment outcome for TB. This study evaluated the burden of HIV and DM in TB cases from Odisha during 2019, and its impact on the TB treatment outcome. METHODS: The study utilized data on TB patients of Odisha during 2019, from the NIKSHAY portal, the health management information system (HMIS) of TB in India. This is a retrospective observational registry-based cohort study, which evaluated a linkage between socio-demographic predictors, clinical diagnostic and treatment predictors, time of treatment predictors, and co-morbidity with TB. Data were retrieved electronically in Microsoft-Excel and analysis was done using STATA 16 (StataCorp. 2019, College Station, TX: StataCorp LLC). RESULTS: Data for 47,831 TB cases of Odisha as study population was extracted from the Nikshay application for the year 2019. The highest prevalence (31.1%, 14,863/47,831) of TB was observed among young participants aged 15-30 years, whereas the prevalence was least among children <14 years (4.4%, 2124/47,831). Males had a higher prevalence of TB (66.7%, 31,878/47,831). Of the 47,831 TB cases included in the study, 7.6% (3659/47,831) had diabetes mellitus (DM), along with TB. 1.2% (571/47,831) had HIV along with TB, while only 0.08% (37/47,831) had both DM and HIV along with TB. 88.2% (3148/3569) of cases with DM and TB had a favorable outcome, compared to 82.3% (449/541) of cases with HIV and TB. People with TB who did not have DM had a significantly higher favorable outcome (OR 1.6, 95% CI 1.5-1.8) compared to those with TB and DM. Similarly, TB cases who did not have HIV infection had a significantly higher favorable outcome (OR 2.4, 95% CI 1.9-3.0) compared to those with TB and HIV. CONCLUSION: Our study showed that presence of DM and/or HIV in TB patients had an impact on the TB treatment outcome. There is a crucial need to prevent comorbidities such as DM and HIV from occurring and to prioritize early diagnosis and management of these conditions.

Endophthalmitis patients seen in a tertiary eye care centre in Odisha: a clinico-microbiological analysis.

BACKGROUND & OBJECTIVES: Geographical variations are known to influence different aspects of endophthalmitis. We report the epidemiological, clinical and microbiological profile of patients with infectious endophthalmitis presented to a tertiary eye care centre in Odisha, India, and compare the results with published reports from other parts of India. METHODS: Retrospective review of medical records of 107 patients, seen between December 2006 and January 2009 was done. All patients had undergone parsplana vitrectomy with intraocular antibiotics and the management was based on microbiological analysis of the vitreous fluid. RESULTS: Forty six (43.0%) patients had post-operative (PO), 43 had post-traumatic (PT) and 18 (16.8%) had endogenous (EG) endophthalmitis. Males were predominant in all three types of endophthalmitis. Significantly younger individuals constituted PT group. While culture established microbial diagnosis in 45 patients (42%), direct microscopy was positive in 38 patients (35.5%). Fungal aetiology was found in 13 patients (PO-7, PT-4, EG-2) and bacteria accounted for 32. Similar to studies from north, central and south India, fungi and Gram-negative bacteria accounted for a large number of PO endophthalmitis cases. Two PT patients had polymicrobial infection. All Gram-positive bacteria were susceptible to vancomycin. Susceptibility to ceftazidime was variable among the Gram-negative bacteria. Best corrected visual acuity (BCVA) at presentation was less than 20/200 in majority (93%) of the patients. While the treatment outcome was variable in fungal and sterile endophthalmitis, the BCVA was either unchanged or improved in 100 per cent of bacterial endophthalmitis patients. INTERPRETATION & CONCLUSIONS: The spectrum of infection and outcome of infectious endophthalmitis in Odisha was similar to other parts of the country. Fungi and bacteria were involved in all three types of endophthalmitis. Empirical use of standard intravitreal therapy is recommended while emphasizing on vitreous biopsy for culture and sensitivity whenever possible.

Development and evaluation of hexaplex PCR for rapid detection of methicillin, cadmium/zinc and antiseptic-resistant staphylococci, with simultaneous identification of PVL-positive and -negative Staphylococcus aureus and coagulase negative staphylococci.

We developed a multiplex PCR to detect the presence of methicillin- (mecA), cadmium/zinc-(czrC) and antiseptic-resistant (qacA/B) staphylococci and to identify Panton-Valentine leukocidin (PVL)-positive and -negative Staphylococcus aureus and coagulase-negative staphylococci (CoNS) from infected and healthy eyes. The assay was validated on 177 staphylococci comprising of 55 each of S. aureus and CoNS isolated from infected eyes and five S. aureus and 62 CoNS isolated from healthy eyes and nine direct ocular samples. Nine direct ocular samples for in situ testing consisted of corneal scrapings (4), conjunctiva swabs (2) and others (3). Multiplex PCR result was correlated with genotype data obtained with single PCR and dot-blot assay. The control strains that were positive in multiplex PCR for 16S rRNA, nuc, mecA, pvl, czrC and qacA/B genes were also positive in the dot-blot assay. The specificity of amplified genes obtained with reference strains was further confirmed by DNA sequencing. The single step-hexaplex PCR method can be used for rapid detection of mecA, nuc, pvl, czrC and qacA/B genes in staphylococci with simultaneous identification of PVL-positive and -negative S. aureus and CoNS from a variety of ocular samples.

Changing profile of organisms causing scleral buckle infections: a clinico-microbiological case series.

PURPOSE: To study the microbiological spectrum and in vitro susceptibility of bacterial isolates from explanted scleral buckles and to correlate clinical presentation to the causative agent. METHOD: Medical records of patients who underwent buckle explantation from July 2007 to May 2012 were reviewed retrospectively. Clinical features and microbiological profile were noted and correlated. RESULTS: Twenty of 24 buckles (83.33%) from 24 patients grew 21 isolates. Isolates included 6 acid-fast bacilli (28.57%; atypical mycobacteria = 5, Nocardia asteroides = 1), 5 gram-positive bacilli (23.8%; Corynebacterium spp. = 4, Bacillus sp. = 1), 4 gram-positive cocci (19.0%; Staphylococcus spp. = 4), 2 gram-negative bacilli (9.5%; Pseudomonas aeruginosa = 2), and 4 fungi (19.0%; Aspergillus spp. = 3, Paecilomyces sp. = 1). Acid-fast bacilli and gram-negative bacilli were sensitive to amikacin and gram-positive bacilli and gram-positive cocci to vancomycin. Buckle exposure within 2 years of primary surgery tended to be noninfective (P = 0.06). Fungal or mycobacterial infections were more symptomatic than those with Corynebacterium species. Results of microscopic examination of conjunctival swab in 5 of 7 eyes (71.4%) were consistent with culture of conjunctival swab and explanted buckles. CONCLUSION: Clinical features and microscopic examination of conjunctival swab may give a lead toward the causative organism in suspected buckle infections. Based on these leads, vancomycin and amikacin may be used as the initial empirical therapy.

Fungal periorbital necrotizing fasciitis in an immunocompetent adult.

A 55-year-old man presented with profound swelling of the upper face and fever with a history of preceding insect bite. He was nonalcoholic and immunocompetent. Orbital CT showed a predominantly preseptal soft-tissue swelling. Empiric treatment with broad-spectrum antibiotics resulted in partial response. Surgical debridement and microbiologic evaluation of the necrotic tissue were performed. Gram stain showed budding yeast cells. Candida and Aspergillus spp. grew in culture after 48 hours. The patient received oral fluconazole, 200 mg once a day for 8 weeks. Complete resolution was documented at 16 weeks. In tropical regions, Candida and Aspergillus spp. may cause periorbital necrotizing fasciitis in immunocompetent adults.