ABSTRACT
AIMS: Comparison of conventional blood culture with BACTEC 9050 for rate and time to detection of microorganisms. SETTINGS AND DESIGN: A prospective study was carried out in a multispecialty tertiary care teaching hospital. SUBJECTS AND METHODS: A total of 835 paired specimens (797 blood and 38 nonblood specimens) were collected and processed according to standard microbiological procedures by both conventional method as well as by BACTEC 9050 automated culture system. Clinical details of patients were recorded. Data were analyzed for time to detection and isolation rate by the two systems and compared. RESULTS: Overall culture positivity for BACTEC 9050 and the conventional system was 32% and 19.88%, respectively. Eighty-five demonstrated concordant growth, 136 specimens were culture positive by BACTEC only, and 38 specimens were culture positive by conventional only. Twelve contaminants in BACTEC and nine contaminants in conventional system were detected. Using BACTEC 9050, higher isolation was observed for Acinetobacter spp., coagulase negative Staphylococcus spp., Streptococcus spp., and Candida spp. A total of 410 patients were on antimicrobial treatment and culture positivity was significantly higher with BACTEC 9050 (P < 0.0001). There was a significant difference in the mean time to detection with BACTEC 9050 recovering 86.8% of isolates within 48 h (P < 0.0001). CONCLUSIONS: Although BACTEC 9050 demonstrated a significantly higher recovery of microorganisms from blood, an appropriately performed conventional blood culture can facilitate the choice of therapy.
Subject(s)
Bacteria , Bacteriological Techniques/instrumentation , Blood Culture/methods , Blood/microbiology , Adolescent , Adult , Bacteria/classification , Bacteria/growth & development , Bacteria/isolation & purification , Bacteriological Techniques/methods , Bacteriological Techniques/statistics & numerical data , Candida/classification , Candida/isolation & purification , Child , Child, Preschool , Culture Media , Humans , Infant , Infant, Newborn , Middle Aged , Sensitivity and Specificity , Young AdultABSTRACT
BACKGROUND & OBJECTIVES: Mother-to-child transmission (MTCT) is the most significant route of HIV transmission in children below the age of 15 yr. In India, perinatal HIV transmission, even after treatment, accounts for 5.4 per cent of HIV cases. The present study was conducted to evaluate the efficacy of anti-retro viral therapy (ART) or prophylactic treatment (PT) to control maternal viral load in HIV positive women, and its effect on vertical HIV transmission to their infants. METHODS: A total of 58 HIV positive women were enrolled at the time of delivery and their plasma samples were obtained within 24 h of delivery for estimation of viral load. Viral load analysis was completed in 38 women. Infants received single dose nevirapine within 2 h of birth and zidovudine for 6 wk. At the end of 18 month follow up, HIV positive or negative status was available in 28 infants. RESULTS: Results revealed undetectable levels of viral load in 58.3 per cent of women with ART compared to 30.7 per cent of women with PT. No women on ART had viral load more than 10,000 copies/ml, whereas seven (26.9%, P=0.07) women receiving PT had this viral load. Median CD4 count of women on PT (483 cells/µl) was high compared to the women on ART (289 cells/ µl). At the end of 18 months follow up, only two children were HIV positive, whose mothers were on PT. One had in utero transmission; infection detected within 48 h of delivery, while the other child was infected post partum as HIV was detected at six months follow up. INTERPRETATION & CONCLUSIONS: Women who received a single dose of nevirapine during delivery had higher levels of viral load than women on ART. Combination drug therapy for pregnant women is now a standard of care in most of the western countries; use of nevirapine monotherapy at the time of delivery in our settings is not effective in controlling viral load. This highlights initiation of ART in pregnant women to control their viral load and thus to inhibit mother to child HIV transmission.
Subject(s)
Antiviral Agents/administration & dosage , HIV Infections/transmission , Viral Load , Female , HIV Infections/prevention & control , Humans , India , PregnancyABSTRACT
BACKGROUND: To improve the empiric antimicrobial therapy of community-acquired (CA) skin and soft tissue infections (SSTIs), it is necessary to generate data on the current spectrum and susceptibility profile of associated bacteria. CA methicillin-resistant Staphylococcus aureus (CA MRSA) is increasingly being reported in SSTIs in India and globally. AIMS: The present study was undertaken to determine the bacterial profile of CA-SSTIs, to know the contribution of MRSA in these infections, to determine inducible clindamycin resistance in S. aureus and to compare the resistance patterns of isolates from hospital-acquired (HA) SSTIs. MATERIALS AND METHODS: Eight hundred and twenty patients with CA SSTIs were prospectively studied. Pus samples were cultured and antimicrobial susceptibility pattern determined. Inducible clindamycin resistance was detected by D-test. Laboratory records were analyzed retrospectively to generate data on HA SSTIs. RESULTS: 619 isolates were recovered in CA-SSTIs, of which S. aureus (73%) and Streptococci (12%) were the most common. Pseudomonas aeruginosa (28%) and Acinetobacter spp (18%) were the predominant HA-SSTI pathogens. Susceptibility of CA S. aureus to antibiotics tested was, penicillin (6%), co-trimoxazole (20%), ciprofloxacin (37%), cefazolin (100%), erythromycin (84%), clindamycin (97%), gentamicin (94%) and fusidic acid (95%). No MRSA was found in CA SSTIs whereas 45% of HA S. aureus strains were methicillin-resistant. HA strains demonstrated significantly higher resistance as compared to their CA counterparts (P<0.001). D test was positive in 22% of CA S. aureus tested. CONCLUSIONS: In CA SSTIs, methicillin-susceptible S. aureus is the predominant pathogen. Penicillinase-resistant penicillins, clindamycin and erythromycin in that order can be used as suitable antimicrobials for empiric therapy. D test should be carried out routinely. No CA MRSA was detected in the present series.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cross Infection/microbiology , Soft Tissue Infections/microbiology , Staphylococcal Skin Infections/microbiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Cross Infection/epidemiology , Drug Resistance, Multiple, Bacterial , Female , Humans , India/epidemiology , Infant , Male , Methicillin Resistance , Microbial Sensitivity Tests , Middle Aged , Prevalence , Prospective Studies , Retrospective Studies , Soft Tissue Infections/epidemiology , Staphylococcal Skin Infections/epidemiology , Staphylococcus aureus/classification , Young AdultABSTRACT
Reactivation of Human Endogenous Retrovirus K (HERV-K), subtype HML-2, has been associated with pathophysiology of amyotrophic lateral sclerosis (ALS). We aimed to assess the efficacy of antiretroviral therapy in inhibiting HML-2 in patients with ALS and a possible association between the change in HML-2 levels and clinical outcomes. We studied the effect of 24-weeks antiretroviral combination therapy with abacavir, lamivudine, and dolutegravir on HML-2 levels in 29 ALS patients. HML-2 levels decreased progressively over 24 weeks (P = 0.001) and rebounded within a week of stopping medications (P = 0.02). The majority of participants (82%), defined as "responders", experienced a decrease in HML-2 at week 24 of treatment compared to the pre-treatment levels. Differences in the evolution of some of the clinical outcomes could be seen between responders and non-responders: FVC decreased 23.69% (SE = 11.34) in non-responders and 12.71% (SE = 8.28) in responders. NPI score decreased 91.95% (SE = 6.32) in non-responders and 53.05% (SE = 10.06) in responders (P = 0.01). Thus, participants with a virological response to treatment showed a trend for slower progression of the illness. These findings further support the possible involvement of HML-2 in the clinical course of the disease.
Subject(s)
Amyotrophic Lateral Sclerosis , Endogenous Retroviruses , HIV Infections , Amyotrophic Lateral Sclerosis/drug therapy , Amyotrophic Lateral Sclerosis/genetics , HIV Infections/drug therapy , HumansABSTRACT
BACKGROUND & OBJECTIVES: Enterococci, classified as group D streptococci, are the second leading cause of nosocomial infections. The incidence of enterococcal infections and species prevalent in India is not thoroughly investigated. The present study was undertaken to isolate and characterize enterococci from clinical specimens and determine the antimicrobial susceptibility pattern of these isolates. METHODS: Clinical specimens (blood, urine and swabs) were cultured on bile esculin azide agar (BEAA) for isolation of enterococci. The phenotype based scheme included Gram staining of growth on BEAA and subculturing of cocci on sheep blood agar plates for vancomycin disk diffusion and hydrolysis of L-pyrrolidonyl-beta-napthylamide (PYR) testing. The phenotypic method was used to surveillance cultures that yielded growth on BEAA. Enterococcal strains were further identified to the species level by conventional biochemical tests. PYR positive isolates were further characterized into vancomycin resistant enterococci (VRE) and nonVRE depending upon vancomycin inhibition zone size. The isolates were characterized into vanA, vanB and vanC depending upon minimum inhibitory concentration (MIC) values. Conventional method was used to study the antibiogram of isolates. RESULTS: A total of 52 isolates of enterococci (10 Enterococcus faecalis, 42 E. faecium) were isolated from 534 clinical specimens. Of the 52 isolates, 12 isolates were resistant to vancomycin with an MIC > 4 microg/ml but sensitive to teicoplanin (vanB isolates). INTERPRETATION & CONCLUSION: Our study reveals the problem of multiple drug resistant enterococci and emergence of VRE. Better susceptibility tests need to be used to measure the vancomycin resistance accurately.
Subject(s)
Drug Resistance, Microbial , Enterococcus/isolation & purification , Streptococcal Infections/microbiology , Enterococcus/classification , Enterococcus/drug effects , Humans , Microbial Sensitivity Tests , PhenotypeABSTRACT
BACKGROUND: The biopsy urease test detects preformed urease in Helicobacter pylori and has excellent sensitivity and specificity for antral biopsies. Similar conclusions cannot be made for biopsies from the body of the stomach as data are scant. METHODS: Endoscopy was performed and biopsies taken from the antrum and body ofthe stomach of 302 patients with dyspepsia to judge the diagnostic accuracy of Christensen's urea and campylobacter-like organism tests. RESULTS: The sensitivity and specificity of Christensen's urea test (n=200) was 97% and 92% for the antrum, and 34% and 85% for the body respectively. The campylobacterlike organism test (n=102) had a 100% sensitivity and specificity for the antrum and a 97% sensitivity and 100% specificity for the body. It was also positive in 97% (31132) and 90% (27/30) of patients at 10 minutes and 30 minutes when the colonization was dense (grade 3), and 90% (27/30) positive at 1 to 3 hours when the density of the organisms was graded as 2. All tests positive at 24 hours (10/10) had densities of grades 1 and 2. CONCLUSIONS: The Christensen's urea test has excellent sensitivity and specificity in the antrum, but its sensitivity in the body is poor because of a low density of organisms. The campylobacter-like organism test is more sensitive and specific than the Christensen's urea test, especially in the presence of low bacterial numbers and its rapidity correlates well with the density of organisms.
ABSTRACT
OBJECTIVE: To compare the age-related prevalence of Helicobacter pylori in populations from developing and developed nations to determine the possible mode of transmission. METHODS: Endoscopic gastric biopsies (for biopsy urease test and histology) were obtained in 526 patients with dyspepsia and in 82 control subjects to determine H pylori prevalence. RESULTS: H pylori prevalence in patients with dyspepsia and in control subjects was 65% and 46% respectively. Age-related prevalence in these two groups in the age groups 10-19 years, 20-29 years, 30-39 years, 40-49 years and > or = 50 years was 52%, 70%, 69%, 60% and 59%, and 44%, 55% 58%, 36% and 33% respectively. CONCLUSION: Exposure to H pylori occurs early in India and is widespread, even in control subjects. The high prevalence of the organism in young Indian control subjects and the comparable prevalence of antibodies to H pylori and hepatitis A virus infection in different age groups both in developed and developing nations may suggest a feco-oral mode of transmission.
Subject(s)
Dyspepsia/complications , Helicobacter Infections/epidemiology , Helicobacter pylori/isolation & purification , Adolescent , Adult , Age Factors , Aged , Biopsy , Child , Developing Countries , Female , Gastroscopy , Helicobacter Infections/microbiology , Humans , India/epidemiology , Male , Middle Aged , PrevalenceABSTRACT
BACKGROUND AND AIM: Dental plaque has been suggested as a reservoir for Helicobacter pylori, though data in this regard are conflicting. We evaluated the prevalence of H. pylori DNA in dental plaque using polymerase chain reaction (PCR). METHODS: Antral H. pylori status of 156 patients with acid-peptic disease (APD) was studied by rapid urease test (RUT), histology and culture. Dental plaque obtained from these 156 patients and 92 healthy volunteers was evaluated for the presence of H. pylori using RUT, culture and PCR. RESULTS: H. pylori was present in 133 antral biopsy samples by RUT and/or histology. The dental plaque of 37 patients with APD and 21 healthy volunteers tested positive by RUT. H. pylori was not isolated by culture from any of the dental plaques. PCR gave a significant amplification product in 11 of 248 (4.4%) dental plaque samples, 7 from patients with APD and 4 from normal healthy volunteers. CONCLUSION: The frequency of H. pylori in the dental plaque is low, and this is unlikely to be a prominent site of infection with H. pylori.
Subject(s)
Dental Plaque/microbiology , Disease Reservoirs , Dyspepsia/microbiology , Helicobacter Infections/microbiology , Helicobacter pylori/isolation & purification , Adult , Case-Control Studies , DNA Primers , Female , Humans , Male , Middle Aged , Polymerase Chain Reaction , PrevalenceABSTRACT
BACKGROUND: The route of transmission of Helicobacter pylori is unknown. Since the organism has been isolated from saliva, gastric juice and stool, medical personnel could be at high risk for acquiring the infection during procedures like gastrointestinal endoscopy. AIMS: To study whether endoscopy is a professional hazard for acquisition of H. pylori. METHODS: We studied the prevalence of IgG antibodies to H. pylori in endoscopists (n = 17), radiologists (n = 17) and personnel from paraclinical branches (n = 35); microbiology (n = 21), pathology (n = 7) and forensic medicine (n = 7); among the paraclinical personnel five were at high risk because they worked with cultures of H. pylori. Subjects answered a questionnaire regarding upper gastrointestinal symptoms, and precautions taken at the work place against infection. The serum was tested for IgG antibodies to H. pylori using a microwell ELISA and a rapid card test. RESULTS: H. pylori antibodies were present in five (29.4%) endoscopists, three (17.6%) radiologists and seven (20%) paraclinical personnel; only one of the 5 high risk para medical personnel was positive. There was no correlation between the duration of performing endoscopies and the H. pylori IgG status. CONCLUSION: Endoscopy is not a risk factor for acquiring H. pylori infection.
Subject(s)
Antibodies, Bacterial/blood , Gastritis/epidemiology , Helicobacter Infections/epidemiology , Helicobacter pylori/immunology , Immunoglobulin G/blood , Occupational Diseases/epidemiology , Patient Care Team/statistics & numerical data , Adult , Allied Health Personnel , Endoscopy, Gastrointestinal , Female , Gastritis/immunology , Helicobacter Infections/immunology , Helicobacter Infections/transmission , Humans , India/epidemiology , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Male , Occupational Diseases/etiology , Occupational Diseases/immunology , Radiology , Risk Factors , Seroepidemiologic StudiesABSTRACT
Sixty patients with Helicobacter Pylori positive non ulcer dyspepsia were randomly allocated to one of the following treatment groups: Group I--norfloxacin 400 mg bid for 10 days, Group II--amoxycillin 500 mg bid plus tinidazole 500 mg bid for 15 days, Group III--colloidal bismuth subcitrate (CBS) 240 mg bid for 4 weeks. H pylori elimination was achieved in 14%, 81%, and 62% in Groups I, II and III respectively. Eradication of H pylori was not observed in Groups I and II, but was achieved in 25% of patients in Group III. Antral gastritis improved in 69% in Group II and 50% in Group III. We conclude that norfloxacin is not effective in H pylori infection. A combination of amoxycillin and tinidazole is highly effective in H pylori elimination with improvement in associated gastritis, but H pylori eradication is not observed with this therapy. CBS is also effective in H pylori elimination though H pylori eradication is achieved in only 25%.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Gastritis/drug therapy , Helicobacter Infections/drug therapy , Helicobacter pylori , Adult , Amoxicillin/therapeutic use , Antacids/therapeutic use , Anti-Ulcer Agents/therapeutic use , Drug Therapy, Combination , Gastritis/microbiology , Helicobacter Infections/microbiology , Helicobacter pylori/drug effects , Humans , Norfloxacin/therapeutic use , Organometallic Compounds/therapeutic use , Tinidazole/therapeutic useABSTRACT
PURPOSE: Polymorphism in cytokine genes may affect its production, which play an important role in modulation of human immunodeficiency virus (HIV) infection. Evaluation of these polymorphisms might help to understand why some individuals remain uninfected in spite of several exposures to HIV infection, such as the negative spouses of discordant couples. The aim of this study was to evaluate the association of 22 single nucleotide polymorphisms (SNPs) in 13 cytokine genes and their receptors with HIV infection in serodiscordant couples, attending the Integrated Counselling and Testing Centre of a Municipality Hospital. MATERIALS AND METHODS: At the end of at least 2 years of follow up, 42 couples were confirmed as being serodiscordant. Genotyping was carried out in blood samples of these couples using the polymerase chain reaction-sequence-specific amplification method. RESULTS: Significantly high frequency of interleukin-1 receptor antagonist IL-1RA mspa 11100 CC (P=0.04), tumor necrosis factor-alpha TNF-α -238 AG (P=0.01) and IL-4 -33 TT (P=0.01) was observed in HIV seropositives (HSP) while frequency of TNF-α -238 GG (P=0.02) was significantly high among the exposed uninfected (EU). However, application of Bonferroni correction identified only two SNPs i.e., TNF-α -238 AG and IL-4 -33 TT to be significantly associated with the acquisition of HIV. In remaining cytokine genes, no significant association was observed. CONCLUSION: Our study highlighted possible association of certain specific polymorphisms with HIV transmission, whereas presence or absence of certain other polymorphism in EU individuals might be offering protection from HIV infection. These variations at the genetic level might help to explore new insights into treatment and HIV prevention strategies.
Subject(s)
Cytokines/genetics , HIV Infections/immunology , Polymorphism, Genetic , Adult , Blood Cells , Disease Resistance , Family Characteristics , Female , Genetic Predisposition to Disease , Genotype , Humans , India , Male , Polymerase Chain ReactionABSTRACT
PURPOSE: Integrated counselling and testing centres (ICTC) provide counselling and blood testing facilities for HIV diagnosis. Oral fluid tests provide an alternative for people who do not want blood to be drawn. Also, it avoids the risk of occupational exposure. The goal of this study was to evaluate the utility of Calypte AWARE HIV-1/2 OMT antibody test as a screening test in an Indian setting. MATERIALS AND METHODS: A cross-sectional study was carried out after ethics committee approval in 250 adult ICTC clients. Blood was collected and tested from these clients for HIV diagnosis as per routine policy and the results were considered as the gold standard. Also, after another written informed consent, oral fluid was collected from the clients and tested for the presence of HIV antibodies. Twenty five clients who had and 25 clients who had not completed their secondary school education (Group A and Group B, respectively) were also asked to perform and interpret the test on their own and their findings and experiences were noted. RESULT: The sensitivity, specificity, PPV and NPV of the oral fluid antibody test were 100%, 98.51%, 94.11% and 100%, respectively. Seventy six percent of clients preferred oral fluid testing. Group B found it difficult to perform the test as compared to Group A and this difference was statistically significant (P ≤ 0.05). CONCLUSION: Oral fluid testing can be used as a screening test for HIV diagnosis; however, confirmation of reactive results by blood-based tests is a must.
Subject(s)
HIV Antibodies/blood , HIV Infections/diagnosis , HIV-1/immunology , HIV-2/immunology , Mass Screening/methods , Saliva/immunology , AIDS Serodiagnosis/methods , Adult , Cross-Sectional Studies , HIV Antibodies/analysis , HIV Infections/immunology , HIV Infections/prevention & control , HIV Infections/virology , Humans , India , Male , Predictive Value of Tests , Reagent Kits, Diagnostic , Sensitivity and SpecificityABSTRACT
AIMS: To determine the prevalent subtypes of HIV-1 in serodiscordant couples. SETTING: Integrated Counselling and Testing Centre (ICTC), Department of Microbiology. STUDY DESIGN: Prospective pilot study. PARTICIPANTS: Thirty HIV-1 serodiscordant couples. INCLUSION CRITERIA: a) Documentation of HIV-1 infection in one partner and seronegative status in the other, current history of continued unprotected sexual activity within the partnership, demonstration that they have been in a partnership for at least 1 year and are not currently on highly active antiretroviral therapy HAART; b) willingness of both partners to provide written informed consent including consent to continued couple counselling for 3 months. MATERIALS AND METHODS: HIV-1 subtyping was carried out by heteroduplex mobility analysis (HMA) by amplifying env region; and DNA sequencing by amplifying gag region. RESULTS: HIV-1 env gene was amplified successfully in 10/30 samples; gag gene, in 25/30 samples; and both env and gag gene were amplified successfully in 5/30 samples. HIV-1 subtype C was detected from 21 samples; subtype B, from 7; and subtype A, from 2. Sample from 1 positive partner was detected as subtype C by env HMA and subtype B by gag sequencing. CONCLUSION: HIV-1 subtype C was found to be the predominant subtype of HIV-1 in serodiscordant couples attending our ICTC, followed by HIV-1 subtype B and HIV-1 subtype A, respectively. DNA sequencing was found to be the most reliable method for determining the subtypes of HIV-1.
Subject(s)
Family Characteristics , HIV Infections/virology , HIV Seronegativity , HIV-1/classification , HIV-1/genetics , Heteroduplex Analysis/methods , Sequence Analysis, DNA/methods , AIDS Serodiagnosis , Counseling , DNA, Viral/analysis , DNA, Viral/genetics , Delivery of Health Care, Integrated , Female , Genes, env , Genes, gag , HIV Infections/epidemiology , HIV-1/immunology , Humans , India/epidemiology , Male , Outpatient Clinics, Hospital , PrevalenceABSTRACT
A case of strongyloidiasis in common variable immunodeficiency is reported here. The patient was given several courses of albendazole without any response.
ABSTRACT
The aim of the study was to observe the relationship between the two reservoirs of Helicobacter pylori--that is, dental plaque and the stomach. With the Campylobacter-like organism (CLO) test, H. pylori was detected in dental plaque and in gastric antral and body mucosa in 98%, 67% and 70%, respectively, of 43 consecutive patients with dyspepsia. The rapidity of the CLO test indicates that the density of H. pylori is heaviest in dental plaque, less in the antrum, and least in the body mucosa of the stomach. Triple drug therapy (bismuth, tinidazole, and amoxycillin or doxycycline) was administered for 15 days to 24 patients. By the CLO test, H. pylori was eliminated from the gastric mucosa in all 24 patients but persisted in dental plaque in all of them. Our observations indicate that dental plaque is unaffected by triple drug therapy and is perhaps a permanent reservoir of H. pylori if local therapy also fails to eradicate the organism.