Recent HIV Infection among men who have sex with men and transgender women in Tijuana

ABSTRACT OBJECTIVE To characterize recent HIV infections among newly diagnosed men who have sex with men and transgender women in Tijuana. METHODS Limiting Antigen (LAg)-Avidity testing was performed to detect recent HIV infection within a cohort of newly-diagnosed men who have sex with men and transgender women in Tijuana. Logistic regression was used to determine characteristics associated with recent infection. A partial transmission network was inferred using HIV-1 pol sequences. Tamura-Nei 93 genetic distances were measured between all pairs of sequences, and the network was constructed by inferring putative transmission links (genetic distances ≤ 1.5%). We assessed whether recent infection was associated with clustering within the inferred network. RESULTS Recent infection was detected in 11% (22/194) of newly-diagnosed participants. Out of the participants with sequence data, 60% (9/15) with recent infection clustered compared with 31% (43/139) with chronic infection. Two recent infections belonged to the same cluster. In adjusted analyses, recent infection was associated with years of residence in Tijuana (OR = 1.5; 95%CI 1.01-1.09), cocaine use (past month) (OR = 8.50; 95%CI 1.99-28.17), and ever experiencing sexual abuse (OR = 2.85; 95%CI 1.03-7.85). DISCUSSION A total of 11% of men newly diagnosed with HIV who have sex with men and transgender women in Tijuana were recently infected. The general lack of clustering between participants with recent infection suggests continued onward HIV transmission rather than an outbreak within a particular cluster.

Decreased memory T-cell response and function in human immunodeficiency virus-infected patients with tegumentary leishmaniasis

The effects of human immunodeficiency virus (HIV) on the immune response in patients with cutaneous leishmaniasis have not yet been fully delineated. This study quantified and evaluated the function of memory T-cell subsets in response to soluble Leishmania antigens (SLA) from patients coinfected with HIV and Leishmania with tegumentary leishmaniasis (TL). Eight TL/HIV coinfected subjects and 10 HIV seronegative subjects with TL were evaluated. The proliferative response of CD4+and CD8+T-cells and naïve, central memory (CM) and effector memory (EM) CD4+T-cells in response to SLA were quantified using flow cytometry. The median cell division indices for CD4+and CD8+T-cells of coinfected patients in response to SLA were significantly lower than those in patients with Leishmania monoinfection (p < 0.05). The proportions of CM and EM CD4+T-cells in response to SLA were similar between the coinfected patients and patients with Leishmania monoinfection. However, the median CM and EM CD4+T-cell counts from coinfected patients were significantly lower (p < 0.05). The reduction in the lymphoproliferative response to Leishmania antigens coincides with the decrease in the absolute numbers of both EM and CM CD4+T-cells in response to Leishmania antigens in patients coinfected with HIV/Leishmania.

Microbiological profile of diabetic foot ulcers and its antibiotic susceptibility pattern in a teaching hospital, Gujarat.

Background: Diabetic foot lesions are a major medical, social and economic problem and are the leading cause of hospitalization for patients with diabetes worldwide. Infection sometimes leads to amputation of the infected foot if not treated promptly. The present study was conducted to isolate and identify the bacterial pathogens associated with diabetic foot ulcer and to find out its antibiotic susceptibility pattern to reduce the risk of complications. Methods: Total 100 pus samples were collected from patients having diabetic foot ulcer, during July to October 2012. Samples were processed as per standard guidelines. Results: Out of 100 pus samples, 73 (73%) yielded growth of organisms making total of 92 isolates. Out of 92 bacterial isolates, 72 were gram negative and 20 were gram positive. Pseudomonas aeruginosa 25 (27%) was most common isolate causing diabetic foot infections followed by 20 (22%) Klebsiella sp., 17 (19%) E. coli, 15 (17%) S. aureus, 6 (7%) Proteus sp. and 4(3%) Enterococci, 2 (2%) Acinetobacter sp. and 2(2%) CONS and 1(1%) Providencia. Out of 72 GNB, 50 (69.4%) were extended spectrum β lactamase (ESBL) producer. Most gram negative isolates were resistant to levofloxacin, gentamicin, ampicillin-sulbactam and gatifloxacin. All GNB were sensitive to imipenem. Out of 15 S. aureus, 9 (60%) were Methicillin Resistant Staphylococcus aureus (MRSA) and were sensitive to vancomycin and linezolid. Conclusions: Pseudomonas sp. was the most common cause of infections. Most isolates were multi drug resistance.

Evaluation of asymptomatic bacteriuria in antenatal women at C. U. Shah Medical College & Hospital, Surendranagar, Gujarat.

Background: Asymptomatic bacteriuria (ASB) refers to the presence of a bacterial isolate in urine culture in an asymptomatic person. Pregnant women with ASB are more likely to develop acute pyelonephritis in later pregnancy, postpartum urinary tract infection, hypertensive disease of pregnancy, anaemia, chronic renal failure, prematurity, low birth weight babies and prenatal death if untreated. The incidence of these can be reduced by treating ASB during pregnancy. Aims & Objective: To study the incidence of asymptomatic Bacteriuria in pregnancy. Material and Methods: Approximate 20 ml of clean catch midstream urine samples were obtained from 100 pregnant women attending the Obstetric Outpatient Department. Samples were processed as per standard guidelines. Results: Microscopic analysis of urine showed pus cells in 5 (45.45%) and Gram's stain smear showed bacteria in 9 (81.81%). Urine culture showed ASB in 11 (11%) pregnant women. Escherichia coli were found in 6 (54.55%), Klebsiella pneumoniae 3 (27.27%), Enterococcus sp. in 1 (9.09%) and Staphylococcus aureus in 1 (9.09%). Antibiotic sensitivity testing showed that all isolates were sensitive to all the antibiotics. Conclusion: Incidence of asymptomatic bacteriuria was 11% in 100 pregnant women. Microscopic analysis of all 11 urine culture positive samples showed pus cells in 5 (45.45%) and Gram's stain smear showed bacteria in 9 (81.81%). The most common bacterial isolate was Escherichia coli (54.54%), followed by Klebsiella pneumoniae (27.27%), Staphylococcus aureus (9.09%) and Enterococcus sp. (9.09%). Urine culture is necessary for screening pregnant women.

Evaluation of the effect of topical cefadroxil on bacterial load of pathogenic staphylococci in anterior nares in human volunteers, comparative study between oral vs. topical cefadroxil.

Background: Cefadroxil has good tissue penetration & exerts more sustained action at the site of infection after oral absorption. Our aim of the study was to check topical cefadroxil has any efficacy over staphylococcal superficial skin infection or not. Methods: Pre-treatment nasal swabs were obtained from 25 healthy human volunteers and bacterial load was recorded. After single application of topical cefadroxil 3% in left anterior nare and placebo (vehicle) in right anterior nare nasal swabs were obtained and results were compared. 150 patients with staphylococcal superficial skin infections were distributed in 4 groups: Group A - oral cefadroxil 500 mg twice daily for 5 days, Group B - topical cefadroxil (0.5 % to 5%) twice daily, Group C - cefadroxil 500 mg orally plus placebo (vehicle) topically twice daily and Group D -cefadroxil 500 mg orally plus cefadroxil preparation topically twice daily. Bacterial load was measured before treatment, on follow up &after clinical cure and results were compared. Results: Topical cefadroxil significantly reduced bacterial load after single application in anterior nare. Topical cefadroxil cured and significantly reduced bacterial load in staphylococcal superficial skin infections within 3 days of treatment. Oral plus topical cefadroxil combination therapy significantly reduced bacterial load and cured infection within 3 days of treatment in patients with moderate to heavy bacterial growth. No any adverse effect was observed during entire study period in any of groups. Conclusions: Topical preparation of cefadroxil is safe and effective in treating staphylococcal superficial skin infections. Combination of oral plus topical cefadroxil showed synergistic effect in infections with moderate to heavy growth. This study is registered at CTRI [REG ID: CTRI/2013/02/003433 REF: REF/2013/02/004576].

Prevalence of metallo-β-lactamase producing pseudomonas spp.(in Tertiary Care Hospital).

Background: Metallo-β-lactamase (MBL) mediated resistance to carbapenem is an emerging threat in Pseudomonas isolates. The aim of this study is to detect metallo-β-lactamase producing isolates of Pseudomonas spp. from various clinical samples from indoor patients in a teaching hospital. Materials and Methods: Total 900 bacterial strains were isolated from different clinical samples from indoor patients. The bacterial strains were isolated and identified as per the standard guidelines. Amongst them 100 isolates of Pseudomonas were taken for the present study. All pseudomonas isolates were subjected to antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method (CLSIs). In all imipenem resistant isolates of Pseudomonas spp., MBL detection was carried out by Imipenem-EDTA combined-disc synergy test (CDST). Results: Out of 100 isolates of Pseudomonas, 44 (44%) were imipenem resistant. Of these 44 isolates, 30 were producing MBL enzyme. 30 MBL positive isolate included 12 (40%) from surgical wards, 10 (33.33%) from tuberculosis ward, 4 (13%) from medicine ward, 2 (7%) from paediatric ward, 1 (3%) from urology ward and 1 (3%) from neonatal ICU. All MBL positive strains were resistant to β-lactams, aminoglycosides and fluoroquinolones. Conclusion: Prevalence of MBL producing Pseudomonas spp. is 30%. The MBL producing Pseudomonas spp. isolates were multidrug resistant. It is important to identify MBL producing pseudomonas isolates in laboratory as may cause serious infections and may cause a nosocomial outbreak.