Clinical spectrum of acute sporadic hepatitis E and possible benefit of glycyrrhizin therapy.

The aim of the present study was to record the spectrum of sporadic hepatitis due to hepatitis E virus infection with special reference to moderate and severe liver disease, described as sub-acute hepatitis. Further, efficacy of glycyrrhizin therapy was studied as an open trial. Sixty-two consecutive patients were registered for the study. The clinical and laboratory profile of the patients was recorded on a preplanned proforma. Moderate and severe hepatitis was arbitrarily defined on the basis of clinical symptoms and serum bilirubin (total) of 10-15 mg% and 16 mg% or higher, respectively, at the time of presentation. It was noted that 22 (36.1%) of acute sporadic hepatitis E patients had moderate or severe liver disease. Glycyrrhizin was administered to these 22 patients by intravenous (IV) route in the dose of 60 ml daily. Therapy was tapered and stopped once significant clinical and biochemical improvement was noted. All patients showed clinical improvement by the seventh day of therapy. Total bilirubin was reduced by 68.9% by the end of 2 weeks of treatment and at this time, reduction in AST and ALT levels was to the tune of 94 and 97%, respectively. Normalization of AST and ALT levels was recorded in 19 patients (86.4%) and total bilirubin in 13 (59.1%) patients within 30 days of commencement of therapy. There were no side effects of IV glycyrrhizin therapy. It is concluded from the results of the present study that over one-third patients with acute sporadic hepatitis E in India have either moderate or severe liver injury. IV glycerrhizin therapy in this group of patients is well tolerated and effective.

Treatment of subacute hepatitis with Lamivudine and intravenous Glycyrrhizin: a pilot study.

Subacute hepatitis is a common and distinct clinicopathological entity due to Hepatitis B and E viruses in India. Lamivudine has been established as a safe and effective antiviral agent for the treatment of chronic HBV hepatitis. This drug was administered orally along with intravenous (I/V) Glycyrrhizin, an immunomodulator drug, in an open pilot trial to assess its efficacy in the treatment of subacute hepatitis. The results establish the safety and efficacy of Lamivudine in combination with I.V. Glycyrrhizin in subacute Hepatitis.

Choice of antibiotics for empiric treatment of serious infections.

We have compared the in vitro activity of commonly used aminoglycosides--Gentamicin and Amikacin with Ciprofloxacin to determine whether the latter has any role in the empiric treatment of serious bacterial infections. Our results indicate that ciproloxacin was comparable or had a better activity than gentamicin or Amikacin against clinical isolates. As it can be administered orally, hospitalization can be avoided in a large number of patients.

Evaluation of direct gas-liquid chromatography of CSF in rapid diagnosis of acute bacterial meningitis.

A comparison of culture and lactic acid level from 50 patients suffering from bacterial meningitis and 25 controls was done to evaluate the role of direct GLC analysis of CSF for early diagnosis of bacterial meningitis. The study revealed that the CSF lactic acid level was higher in 48 out of 50 cases. Only in 30 patients the causative agent of the disease could be established by conventional techniques. Quantitative estimation of lactic acid was found to be useful.

Multidrug resistant Salmonella typhi in Delhi.

In 1990, we isolated 158 strains of Salmonella typhi from blood cultures of patients suffering from typhoid fever. Seventy nine (50%) of these isolates were found to be simultaneously resistant to chloramphenicol, ampicillin and cotrimoxazole. These strains were also resistant to streptomycin and tetracycline, but sensitive to gentamicin, amikacin and cephalexin. The minimum inhibitory concentrations of chloramphenicol and trimethoprim for a representative number of these strains were found to be greater than 1024 micrograms/ml and greater than 128 micrograms/ml respectively. Majority of the multidrug resistant (MDR) strains tested against cefotaxime (23/23), ciprofloxacin (38/38) and amoxycillin plus clavulanic acid (23/24) were sensitive to these drugs.

Infections in acute myeloid leukemia. Study of 184 febrile episodes.

We analysed the case records of 75 patients with acute myeloid leukaemia treated at our institute from January 1984 to December 1988 to see the pattern and severity of infections and their relationship with granulocytopenia. A total of 184 febrile episodes (mean 2.45) were recorded; 153 (83.15%) were associated with granulocytopenia while 31 (16.84%) were without granulocytopenia. Among granulocytopenic patients, infections could be documented microbiologically in 58.2% and clinically in 30.0% of episodes. In the remaining 41.8% of episodes, no clinical, radiological or microbiological evidence could be found out. The various sites of infection were: septicaemia 21 (13.72%), disseminated fungal infections 4 (2.6%), upper respiratory tract 21 (13.7%), chest 58 (37.9%), gastrointestinal tract 8 (5.2%), genitourinary (7.2%), soft tissues 5 (3.2%) and skin cellulitis 7 (4.6%). Microbiologically, gram negative organisms (Klebsiella pneumoniae, E coli, Pseudomonas aeruginosa) were most common, followed by gram positive (Streptococcal faecalis, Staphylococcus aureus, Staph albus, Staph epidermidis). Four patients had disseminated fungal infection: candida 2, aspergillus *1, mucormycosis *1. Among non neutropenic febrile episodes, the sites infected were: septicemia 2 (6.4%), chest 9(29.0%), upper respiratory tract 1 (3.2%), gastrointestinal 1 (3.2%), soft tissue 1 (3.2%), drug fever 3 (9.6%) and fever of unknown origin 14 (45.2%).

Chlamydia trachomatis in pelvic inflammatory disease.

C. trachomatis seems to be an important causative organism of pelvic inflammatory disease (PID) as C. trachomatis antigen and/or antibody was found in 234 (69.85%) of 335 patients clinically diagnosed to have PID. Antigen was detected in the lower genital tract of 118 (35.22%) patients whereas IgG antibody was present in 188 (56.11%), of whom 89 (47.34%) had a high titre. Repeat testing of sera of 37 patients showed a rise in antibody titre in 18 (40%). As the success rate of therapy for PID with doxycycline was found to be 80 per cent, early diagnosis and treatment may be recommended to prevent further complications of PID.

Latex agglutination test: an adjunct to the laboratory diagnosis of pyogenic bacterial meningitis.

Gram stain, culture and latex agglutination test (LAT) of cerebrospinal fluid were performed in 50 patients clinically diagnosed as suffering from pyogenic bacterial meningitis. Using all the three techniques, an aetiological diagnosis was made in 27 (54%). Neisseria meningitidis, Streptococcus pneumoniae and H. influenzae were the infecting organisms in 21 cases (44%). There were 12 additional cases in which LAT was the only clue to the diagnosis as compared to conventional techniques. Propionibacterium acnes was isolated from one case of anaerobic meningitis. It is concluded that LAT is an adjunct to conventional techniques in the diagnosis of pyogenic bacterial meningitis, where the latter tests fail.

Susceptibility of clinical isolates to cephalexin, cefazolin and cefotaxime.

Three hundred and seventeen recent clinical isolates were tested for in vitro susceptibility to the three cephalosporins available in India--cephalexin, cefazolin and cefotaxime by the Kirby--Bauer disc diffusion method. Cefazolin was the most effective cephalosporin against Gram positive cocci (71.8% sensitive) followed by cefotaxime (62.7%) and cephalexin (52.7%). Cefotaxime was very effective against commonly isolated Gram negative bacilli with only 10 (8.8%) isolates being resistant to it while 44 (39%) and 65 (57.5%) were resistant to cefazolin and cephalexin, respectively. All isolates of Pseudomonas aeruginosa were resistant to cephalexin and cefazolin and only 29 (32.6%) were sensitive to cefotaxime.