SXT constin among Vibrio cholerae isolates from a tertiary care hospital.

Background & objectives: The SXT element, also known as ‘constin’ (conjugable, self transmissible, integrating element) is an integrating conjugative element (ICE) in Vibrio cholerae discovered in the chromosome of epidemic V. cholerae O139 strain MO10 (SXTMO10) which arose in late 1992 in Chennai, India. SXT related ICEs have become widespread and currently, most if not all Asian V. cholerae clinical isolates contain SXT related ICEs. The present study attempts to determine the presence of SXT Int gene in V. cholerae recovered between 2005 to 2007 in a tertiary care hospital, demonstrate its conjugal nature and also detect co-presence and co-transfer of plasmids in representative isolates. Methods: This prospective study was done on 116 V. cholerae isolates [114- O1 (107 ogawa and 7 inaba) and 2 - Non O1 Non O139 V. cholerae] from watery stools between 2005 to 2007 recovered from equal number of patients. PCR was carried out using SXT Int specific primers that produced a 592 bp internal fragment of SXT element, and rifampicin resistant strain of E.coli K-12 was used as recipient in conjugation experiments to study transfer of SXT, as also co-transfer of resistance to tetracycline, erythromycin, and nalidixic acid. Antibiotic susceptibility was performed against various antibiotics. Results: Of the 116 isolates, 110 (94.8%) were positive for SXT element by PCR. It was demonstrated in 94.7 per cent of the O1, and 100 per cent of non O1 non O139 V. cholerae. All 2005 isolates, 25 per cent of 2006 isolates and 96.6 per cent of 2007 isolates were positive for SXT. Thirty two drug resistance patterns were observed and the 2007 isolates showed resistance to as many as eight antibiotics. The resistance of SXT positive isolates was higher than those of SXT negative and the typical drug resistance pattern corresponding to SXTET and SXTMO10 was shown by only one V. cholerae O1 isolate. Successful conjugal transfer of SXT was seen in 31 (88.6%) of the 35 isolates studied without any co-transfer while, presence of plasmids was observed in two of the 31 donor V. cholerae studied. Interpretation & Conclusions: The demonstration of SXT element and its successful horizontal transfer in V. cholerae isolates studied emphasizes the need for its detection to monitor antibiotic resistance and dissemination in V. cholerae.

Mycobacterium avium bacteremia and dual infection with mycobacterium avium and mycobacterium wolinskyi in the gut of an aids patient – First case report.

An AIDS patient was admitted to a tertiary care hospital in central India with fever, weight loss, breathlessness, night sweats, diarrhoea, BMI 14kg/m2, Hemoglobin 8gm% and CD4 counts 120 cells/cumm. His blood culture by BACTEC 460 TB system revealed Mycobacterium avium bacteremia and stool culture grew Mycobacterium avium and mycobacterium wolinskyi.

Bacteriological Profile of Epidural Catheters.

The bacteriological profile of epidural catheters was studied in 88 patients. Skin swabs before catheterization and before removal of catheter with their controls were cultured in TSB Medium. The catheter hub, the portion at the skin puncture site and at the tip were cultured in TSB Medium. The 1cm of the catheter bit just before the tip was cultured in TGB medium for anaerobes.Both, the skin controls swabs and the anaerobic culture, were negative. From the remaining, 56 positive cultures were obtained. Staphylococcus epidermidis was the predominant organism in 52% followed by staphylococcus aureus 25%. The remaining 23% was shared by Acinetobacter, Pseudomonas, Klebsiella, and E. coli. All the positive cultures from skin prior to epidural catheterization had turned sterile by 48 hours, indicating continued bactericidal action of the disinfectant. The likely source of positive skin cultures at 48 hours is hair follicles.The catheter tip culture was positive in 9 specimen, none of which resulted in the formation of epidural abscess. In 3 cases the cultures of skin puncture site and the tip were identical indicating tracking-in of the organisms.

Evaluation of bacteriological diagnosis of smear positive pulmonary tuberculosis under programme conditions in three districts in the context of dots implementation in India.

Objective: To study the smear and culture positivity rates in pulmonary tuberculosis patients declared as smear positive in the districts of North Arcot (Tamil Nadu), Raichur (Karnataka) and Wardha (Maharashtra) in India in order to evaluate the diagnosis of pulmonary tuberculosis at the field level under programme conditions. Methods: Two specimens of sputum from each of 320 patients in North Arcot, 314 patients in Raichur and 302 patients from Wardha district, all of whom had been reported as smear-positive at the field level, were examined by smear and culture. Findings: The proportion of specimens found to be smear-negative was 4.7% in North Arcot and 5.7% in Raichur as against 38.7% in Wardha. The proportions of culture negative specimens were 5.7% and 6.3% respectively in North Arcot and Raichur, while it was 35.6% at Wardha. The difference in the smear and culture negativity between Wardha and the other two districts was highly significant. Conclusions: The study revealed an unacceptably high level of false positives in sputum smear microscopy in the Wardha district. This could be attributed to the absence of systematic and intensive training in smear examination consequent to the non-implementation of the DOTS strategy in this district and a high standard of training offered in the RNTCP implemented districts.

Isolation of mycobacterium avium complex and M Simiae from blood of AIDS patients from Sevagram, Maharashtra.

Background and Methodolgoy: Mycobacterium avium complex (MAC) has not been reported as an opportunistic pathogen among patients with AIDS in the Indian subcontinent. Blood samples were cultured for mycobacteria using BACTEC 460TB system from 71 HIV seropositive and 33 seronegative patients, tested at Mahatma Gandhi Institute of Medical Sciences, Sevagam between August 2001 and December 2002. Results: MAC and M. simiae were isolated from three patients each. All the six patients with mycobacteremia were AIDS cases. Clinically, none of them was diagnosed as a case of mycobacteremia. However, laboratory results confirmed the dissemination of MAC and M. simiae among these patients. Conclusion: These results confirm that disseminated MAC and M. simiae disease exist among AIDS patients in India also.