Central nervous system involvement in scrub typhus.

Scrub typhus is an emerging infectious disease in India. Among its protean clinical manifestations, central nervous system involvement is common. In this prospective observational study, altered sensorium, headache, seizures and aseptic meningitis were found to be common central nervous system manifestations. Prompt treatment with doxycycline reduces morbidity and mortality.

Pagers and stethoscopes as vehicles of potential nosocomial pathogens in a tertiary care hospital in a developing country.

It has long been recognized that stethoscopes and other inanimate objects carry virulent micro-organisms that can cause nosocomial infections in susceptible patients. Among the frequently used items in hospitals are pagers and stethoscopes. The manner in which these items are used has the potential to cause colonization of bacteria and transfer of these bacteria to another person. This prospective study was performed in order to assess the colonization rates among randomly selected pagers and stethoscopes. We found that 15 (25%) pagers and 11 (27.5%) stethoscopes were contaminated. Enterococci (10%) were the most common isolates found followed by Staphylococci (8%) and Enterobacteriaceae (7%). There was no significant difference in the rates of colonization between shared and personal pagers (P = 0.16). Stethoscopes were more likely to be contaminated with Enterococci compared to pagers (P = 0.013, 95% confidence interval 1.3-52.9). Our findings confirm the need for protocols to prevent transmission of infection through inanimate objects.

Azadirachtin poisoning: a case report.

The use of neem-based products is widespread in the Indian Subcontinent. Neem-based pesticides obtained from neem kernels are considered natural and safe. The toxic effects of ingestion and overdose of this pesticide in adults have not been described in this literature. We report the case of a 35-year-old lady who had consumed Azadirachtin in an attempt of deliberate self-harm. The patient had features of neurotoxicity because of Azadirachtin requiring intensive medical care with mechanical ventilation. The patient survived the overdose with no long-lasting side effects of the toxin.

Primary aorto-enteric fistula: a rare complication of abdominal aortic aneurysm.

A 70-year-old lady presented with recurrent gastrointestinal bleeding and septicemia caused by multiple enteric pathogens. She was diagnosed to have primary aorto-enteric fistula (PAEF) complicating abdominal aortic aneurysm. Endovascular aneurysm repair was carried out that arrested gastrointestinal bleeding, but despite prolonged antibiotic therapy the patient died a month later of probable sepsis. PAEF refers to abnormal communication between the aorta and the intestine resulting from disease at either site; this rare condition should be suspected in patients with abdominal aortic aneurysm who present with unexplained life-threatening gastrointestinal bleeding. Computerized tomography is the most sensitive investigation. Presence of ectopic gas adjacent to or within the aorta and of contrast within the gastrointestinal tract is the pathognomonic finding. Definitive treatment consists of surgical intervention, but it is associated with high risk in the acute setting. Endovascular therapy using stent-grafts is safe and effective in arresting gastrointestinal bleeding. However, it is frequently associated with recurrent sepsis even with continued antibiotic therapy, and should be considered as a bridge to more definitive surgical repair at a later time, after optimization of the patient's condition.

Tuberculosis among healthcare workers in a tertiary-care hospital in South India.

It is possible that tuberculosis is transmitted from patients to healthcare workers (HCWs). However, there are few data on this from developing countries. The object of this study was to document the incidence of tuberculosis among HCWs in the Christian Medical College (CMC), Vellore, India during a 10-year period (January 1992-December 2001). Data were collected from records maintained in the staff and students health services of CMC. A total of 125 cases were diagnosed during the period of study. The overall incidence of sputum positive cases was similar to that observed in the general population, during most years. However, it appears that focal outbreaks occur with transmission between HCWs. The chance of developing extra-pulmonary tuberculosis was higher in HCWs compared with the general population.