Longitudinal study to assess socio-demographic profile and treatment outcome of new sputum smear positive cases at designated microscopy centre of tertiary care hospital

Background: Tuberculosis (TB) remains one of the world’s deadliest communicable diseases. In 2013, an estimated 9.0 million people developed TB and 1.5 million died from the disease, 360 000 of whom were HIV-positive. Of the estimated 9 million people who developed TB in 2013, more than half (56%) were in the South-East Asia and Western Pacific Regions and India and China alone accounted for 24% and 11% of total cases, respectively. India’s TB Control Program is on track as far as reduction in disease burden is concerned there was 50% reduction in TB mortality rate by 2013 as compared to 1990 level. Tuberculosis prevalence per lakh population reduced from 465 in year 1990 to 211 in 2013. But still, in India there is high burden of Tuberculosis cases and high mortality in the current situation.Methods: Descriptive Longitudinal study was conducted from 1st January 2015 to 31st December 2016 at designated microscopy centre (DMC) in tertiary care hospital of Government Medical Miraj.Results: Maximum of TB cases 47 (30.71%) were from >30-45 age group and 72 (47.05%) cases belongs nuclear family. 126 (82.35%) cases had completed their treatment schedule for 6/7 months were labelled ‘cured’ at the end of study, while among 27 (17.65%) cases 17 (11.11%) ‘Died’ during treatment schedule, 9 (5.88%) cases became ‘defaulters’ and 1 (0.65%) case was ‘failure’.Conclusions: In the present study, Maximum cases were from >30-45 yrs age group and proportions of males were more as compare to females. Hindus was predominantly more in number among all religions and number of cases coming from rural area was more. The association between gender and treatment outcome of study cases was found statistically significant.

Antibiotic Susceptibility Pattern from Pathogens Causing Acute Pyogenic Meningitis in a Teaching Hospital, South India.

Background and Objectives: Acute pyogenic meningitis is one of the most serious infections in infants and children. It is associated with serious complications and risk of morbidity and mortality. The purpose of present study was to identify the pathogen in acute pyogenic meningitis and to determine its antibiotic susceptibility pattern. Methods: Present study was undertaken for a period of one year from July 2009 to June 2010 included 100 CSF samples of clinically suspected acute pyogenic meningitis cases in children below 12 years. The samples were subjected to Gram’s stain, culture and antibiotic sensitivity test. The cases positive in either of Gram stain or culture were diagnosed as acute bacterial meningitis cases. Results were tabulated and antibiotic sensitivity pattern was compared. Results: Of the 100 cases studied, 26 cases were diagnosed as acute bacterial meningitis. Gram’s stain positivity was 73% (19/26 cases), culture positivity was 100%. The most common organism isolated in the study was Streptococcus pneumoniae, followed by Haemophilus influenzae, Escherichia coli and Klebsiella pneumoniae. Aminoglycosides, cefotaxime and cotrimoxazole showed high sensitivity. Interpretation and conclusion: Though Gram stain is very essential in diagnosis of meningitis, it may miss some cases. Culture and latex agglutination tests overcome this disadvantage. Streptococcus pyogenes still remains predominant pathogen. Antibiogram of the bacteria causing meningitis is also slowly undergoing a change. This calls for change in the empirical therapy for bacterial meningitis cases.

Speciation of coagulase negative Staphylococcal isolates from clinically significant specimens and their antibiogram.

Background: Despite their frequency as contaminants, coagulase-negative Staphylococci (CONS) have become important nosocomial pathogens, accounting for 9% of all nosocomial infections. These infections are diffi cult to treat because of the risk factors and the multiple drug resistance nature of these organisms. Materials and Methods: One hundred and two consecutive CONS were isolated from various clinical samples like blood, pus, urine, urine catheter tip and gastric lavage. Most of the blood samples were from patients with risk factors (immunocompromised or on medical devices). After confi rming the isolates as CONS, species-level identifi cation was performed by simple, non-expensive conventional methods and antibiotic sensitivity testing was also carried out. Results: Of 102 CONS isolates, 100 isolates could be identifi ed to the species level. Among the 100 isolates, epidermidis was the most common species isolated, seen in 32%, followed by S. hemolyticus (18%), S. lugdunensis (12%), S. hominis (10%), S. saprophyticus (8%), S. capitis (6%), S. caprae (4%), S. xylosus (4%), S. cohni and S. warneri (3% each). In the present study, 56% of the isolates were methicillin-resistant CONS. Most of the isolates showed resistance to ampicillin and amoxyclav (89% each), followed by ceftriaxone (52%), cotrimoxazole (46%), cefotaxime (32%), gentamicin (25%), amikacin (21%). Conclusion: The increased pathogenic potential and multiple-drug resistance demonstrates the need to adopt simple, reliable and non-expensive methods for identifying and determining the antibiotic sensitivity of CONS.

Torsion of appendices epiploicae masquerading as ogilve’s syndrome.

Torsion of appendices ep loicae is an uncommon differential diagnosis of a patient presenting with acute abdominal pain and its presentation as a Ogilvie’s syndrome or colonic ileus is even rare.The diagnosis requires a keen suspicion on the part of the attending surgeon. Preoperative computrized tomography ( CT) may help in the diagnosis but the final diagnosis is established only on the operating table . Adding this pathology to the existing list of the causes of colonic ileus /Ogilvies syndrome may give us a good insight into the understanding of the condition&improvise our management. This is a case report of 60 year old lady who was referred to us with nonspecific abdominal pain , distention of abdomen and vomiting from orthopaedics department , where she was being planned for surgery for intertrochanteric fracture femur. All our investigations were equivocal and suggested a Ogilvie’s syndrome like picture .Atrial of neostigmine therapy was also given after excluding physical obstruction and the patient did not respond and the patient was operated upon and intraoperative finding of torsed epiploic appendage was found as the cause of her symptoms. The patient made a good post operative recovery following surgical excision of torsed epiploic appendages. This case should give us another dimension of thought in the management of such cases and help improvise our management.

ESBL- A continuous diagnostic challenge to clinical microbiology laboratories.

Objectives: Extended spectrum beta lactamase (ESBL) producers have posed a great threat to the use of many classes of antibiotics, particularly cephalosporins. Their detection has proved to be difficult for many laboratories because the resistant ESBL producing organisms appear to be susceptible by in vitro routine testing but result in treatment failure.The present study aims to detect the prevalence of ESBLs in organisms like E.coli and Klebsiella spp. which are responsible for many serious infections. Method: Isolates were screened for ESBL production using cefotaxime, ceftazidime and ceftriaxone by disk diffusion method. Isolates showing resistance to one or more than one of these drugs were futher subjected to Phenotypic Confirmatory Test (PCT) using CAZ/CAZ-CAC as per CLSI guidelines. Results: Of the 230 isolates, 116 (50.43%) tested positive by initial screening method. But on PCT only 94 tested positive. Out of 94 ESBL producers, 59 (62.76%) were E.coli and 35(37.23%) were Klebsiella spp. Of the various clinical samples urine 90(39%) showed maximum number of ESBL producers (32, 34%), followed by pus (27, 29%). Out of 230, 126 (54.7%) were females and 104 (45.2%) were males with a male to female ratio of 0.82:1 showing female preponderance. This study also showed increasing resistance to fluoroquinolones among ESBL producers. Conclusion: The results of our study show that there is an increased prevalence of ESBL producers in our tertiary care centre and also an increased resistance to fluoroquinolones among ESBL producers. Hence infections caused by E.coli and Klebsiella spp. which are prime producers of ESBL have to be considered seriously and proper screening methods and antibiotic policies have to be drawn to confine their spread.

ESBL production: Resistance pattern in escherichia coli and klebsiella pneumoniae, a study by DDST method.

Objectives: Resistance to third generation cephalosporins in E. coli and K. pneumoniae are due to various factors. The present study was undertaken to detect resistance mediated by ESBL’s. Multidrug resistance in isolates producing ESBL was also studied. Methods: The study included a total of 200 clinical specimens which include 95 urine, 45 pus, 32 sputum, 11 blood, 9 throat swabs, 6 suction tips and 2 vaginal swabs. The E. coli and K. pneumoniae isolates which were screen positive were studied for ESBL production by DDST method. Results: Culture of 200 samples yielded 200 isolates (117 E. coli and 83 K. pneumoniae). Out of these, 98 (49%) were screen positive for ESBL. Among them 79 (53 E. coli and 26 K. pneumoniae) were found to produce ESBL. Among them, 4 (7.6%) isolates of E. coli and 4 (15.3%) isolates of K. pneumoniae were positive by DDST method. The prevalence of 39.5% of ESBL production was noted in the present study. Among ESBL positive isolates, 98.1% were resistant to cefoxitin, however all of them were susceptible to imipenem. Conclusion: The prevalence of ESBL producing E. coli and K. pneumoniae was found to be high and routine screening of ESBL should be preformed on all isolates showing decreased susceptibility to one or more of third generation cephalosporins.