A community-based study on nasal carriage of Staphylococcus aureus.

Background & objectives: Community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is a major global problem. Colonization rates of MRSA in the community have been reported to range from 0 to 9.2 per cent. The present study was conducted to detect S. aureus nasal colonization and prevalence of MRSA in children (5 to 15 yr) in an Indian community setting of rural, urban and semiurban slums, as also evaluation of an in-house PCR to detect MRSA. Methods: Nasal swabs from children were cultured and S. aureus isolates were processed for antibiotic susceptibility. mecA gene was studied by polymerase chain reaction (PCR) on S. aureus isolates and directly from enrichment broth aliquots inoculated with nasal swabs, at sequential time intervals. Results: The overall prevalence of S. aureus nasal colonization was 52.3 per cent and that of MRSA 3.89 per cent. CA-MRSA nasal carriage was 3.16 per cent in children without prior exposure to health care settings. PCR detection directly on nasal swabs and enrichment broth had a poor sensitivity of 60.42 per cent. Interpretation & conclusions: There was a high rate of S. aureus nasal colonization in the 5-15 yr age group and an alarming rate (3.89%) of community acquired methicillin resistant S. aureus nasal colonization in the community. PCR as a method of direct detection of MRSA from nasal samples needs further fine tuning.

Congenital rubella and cytomegalovirus infections in and around Chandigarh.

AIMS: This study has analyzed the role of rubella and cytomegalovirus (CMV) in infections of children and pregnant women. SETTINGS AND DESIGN: The study was carried out in a tertiary care hospital. Data from blood samples from pregnant women (asymptomatic and also women with obstetric problems) and children (suspected of intrauterine infections) that were received in the laboratory over a period of 8 years were analysed. MATERIALS AND METHODS: The samples were tested for rubella- and CMV-specific IgM antibodies by capture enzyme linked immunosorbent assay. RESULTS: In children, the overall positivity for rubella- and CMV-specific IgM antibodies was 2.8% and 12.5%, respectively. In asymptomatic pregnant females, rubella positivity was 0.7% while in women with obstetric complications it was 3.4%. IgM antibody positivity in cases of CMV was 7.8% in both asymptomatic pregnant women and also in women with obstetric complications. CONCLUSIONS: The study indicated that infection with CMV is more common than the rubella virus. The incidence of rubella has reduced over the past few years. Hence, screening for rubella infection may be reserved for women with obstetric complications only. The routine screening for CMV among all antenatal cases is a debatable issue.

Neurosyphilis in a tertiary care hospital in north India.

BACKGROUND AND OBJECTIVES: The clinical diagnosis of neurosyphilis is very rarely encountered today in the developed world although syphilis remains a significant health problem in few areas of the industrialized countries and in most of the third world nations. This apparent decline may be due to increase in number of asymptomatic neurosyphilis and cases presenting as subtle, illdefined syndromes rather than classic presentation of tabes dorsalis and general paresis in the post penicillin era. This retrospective study was carried out to report the neurosyphilis cases diagnosed at a tertiary care hospital in North India, and to analyse the laboratory and clinical parameters of these cases. METHODS: Suspected cases of neurosyphilis presenting at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh over a period of 13 yr (January 1990 to December 2002) were identified. Diagnosis of neurosyphilis was based on clinical presentation, prior history of syphilis, routine CSF biochemistry (protein and leukocytes) and serological evidence [serum and CSF venereal disease research laboratory (VDRL) and Treponema pallidum particle agglutination (TPPA) tests]. RESULTS: A total of 25 cases of neurosyphilis were identified, 18 (72%) with reactive CSF-VDRL, 22 (88%) with elevated CSF protein and 24 (96%) with CSF mononuclear leukocytosis. Serum VDRL was reactive in all 25 cases. Three patients were asymptomatic (2 primary syphilis; 1 early latent stage), 8 had secondary and 14 had tertiary syphilis. Two of the neurosyphilis cases were also seropositive for HIV. Radiology was abnormal in 7 (28%) patients. INTERPRETATION AND CONCLUSION: Neurosyphilis still remains a problem in a country like India and a high index of suspicion and clinical expertise are required for appropriate diagnosis and proper management especially in the era of AIDS pandemic.

Central nervous system fungal infection--a report of three cases.

Fungal infections of the central nervous system in three apparently immunocompetent patients are being reported. Two cases of cerebral aspergillosis presenting as intracranial granulomas such as rhinocerebral and intracranial forms, and one of cryptococcal meningitis could be successfully diagnosed by newer diagnostic modality such as antigen detection techniques. The case with cryptococcal infection had typical neuroimaging feature which helped to suspect the underlying diagnosis. Aspergillus galactomannan detection in the cerebrospinal fluid helped in the early diagnosis and appropriate therapy of one patient.

Rapid diagnosis of vaginal carriage of group B beta haemolytic streptococcus by an enrichment cum antigen detection test.

BACKGROUND & OBJECTIVES: Group B beta haemolytic streptococcus (GBS) is a frequent colonizer of the maternal genital tract causing peripartum fever, puerperal sepsis, neonatal sepsis and neonatal meningitis. The conventional methods for detection of maternal colonization take 24-48 h. We made an attempt to standardize a rapid enrichment cum antigen detection test to screen pregnant women for GBS colonization in less than 8 h, so as to enable early institution of measures to prevent neonatal sepsis. METHODS: Vaginal swabs of 100 women >36 wk of gestation were inoculated onto enrichment broth (Todd Hewitt broth with lysed horse blood and antibiotics). After incubation for 1,2,4,6, and 18 h, the broth was cultured on sheep blood agar. In culture positive cases, the enrichment broth was subjected to antigen detection by latex agglutination test (LAT). For further evaluation of the rapid test, another group of 100 pregnant women were screened for GBS carriage by 6 h enrichment broth culture followed by antigen detection test. RESULTS: Five of the first group yielded GBS on culture and all were positive for GBS antigen after 6 h enrichment. Thirteen of the second group were positive for the antigen, but GBS could be isolated in ten only. This enrichment cum antigen detection test showed sensitivity, specificity, and positive and negative predictive values of 100, 98.4, 83.3 and 100 per cent respectively and could detect as few as 10(3) cfu/ml organisms. Maternal vaginal carriage of GBS was 7.5 per cent (15/200). INTERPRETATION & CONCLUSION: Six hours of enrichment followed by antigen detection proved to be a rapid and reliable method for detection of GBS colonization. This test is easy to perform making it an ideal test for screening GBS vaginal colonization at labour and starting chemoprophylaxis, where indicated on the same day, before the woman is discharged.