Rapid Response to Syphilis Outbreak among Female Sex Workers.

BACKGROUND: Outbreak of syphilis, i.e., 16 cases of rapid plasma reagin (RPR) reactive cases of syphilis was reported in Community Based Organization (CBO) Sahyog of Surat, India, from April to August 2014. The aim of the study was to find risk factors and take immediate actions to prevent spread. MATERIALS AND METHODS: Outbreak investigation of 16 Female Sex Workers of CBO Sahyog in Surat who were found Rapid Plasma Reagin (RPR) and Treponema Pallidum Hemagglutination Assay (TPHA) positive from April to August 2014; was carried out. Clinico-epidemiological and laboratory-based evidence for different sexually transmitted infections (STIs) conducted at Government Medical College, New Civil Hospital, Surat. Root cause analysis (RCA) of index case was carried out. RESULTS: Desk review for the past 3 years data of STI revealed total STI cases as 88 (2011), 95 (2012), and 130 (2013), of which 4, 2, and 2 found RPR reactive, respectively. Data from April to August 2014 revealed 16 RPR reactive cases and confirmed by TPHA. On examination, one had ulcerative cervical lesion, rest did not have any symptoms of syphilis. Eleven had vaginal/cervical discharge, 11 had lower abdominal pain. A total of 11 had unprotected sex, 7 encountered condom tear in the past 6 months, and 5 reported sexual violence. Seven had sexual activity under influence of alcohol. Laboratory investigation revealed two as HIV-positive. RPR reactivity reported highest (9 out of 16) from same area of hotspot. RCA of probable index case revealed factors responsible as violence and nonuse of condoms. CONCLUSIONS: Outbreak investigation revealed one probable index case. All 16 treated with injection Penidure. Violence or condom tear is responsible for the spread. Crisis management team should be strengthened.

Antibiotic sensitivity pattern in blaNDM-1-positive and carbapenemase-producing Enterobacteriaceae.

BACKGROUND: Some studies published in recent time revealed that many bacteria from Enterobacteriaceae group are multi-antibiotic-resistant because of the production enzymes carbapenemase particularly New Delhi metallo-beta-lactamase encoded by gene called blaNDM-1. Looking at public health importance of this issue there is a need for studies at other centers to confirm or refute published findings. OBJECTIVES: This study was designed with the aim of exploring antibiotic resistance in Enterobacteriaceae group of bacteria and also to explore gene and enzyme responsible for it. MATERIALS AND METHODS: Samples of Enterobacteriaceae were collected from wards and outpatient departments. Antibiotic sensitivity was checked by an automated system (VITEK 2 COMPACT). Carbapenemase production was assessed by Modified Hodge Test. Presence of blaNDM-1 was assessed by polymerase chain reaction. STATISTICS: Frequency and percentage were used to describe the data. Frequency of sensitivity was compared between carbapenemase producers and noncarbapenemase producers by Fisher's exact test. RESULTS: Forty-seven percent bacteria were found to be producing carbapenemase enzyme. These bacteria were significantly less sensitive to cefoperazone, cefepime, and amikacin. Among carbapenemase-producing organisms, 3% and 6% were resistant to tigecycline and colistin, respectively. Forty percent bacteria were found to be having blaNDM-1 gene. There was a significant difference between blaNDM-1-positive and blaNDM-1-negative for sensitivity toward cefoperazone + sulbactam, imipenem, meropenem, amikacin, tobramycine, ciprofloxacin, and levofloxacin. CONCLUSION: Presence of carbapenemase enzyme and blaNDM-1 gene is associated with high level of resistance in Enterobacteriaceae group of bacteria and only few antibiotics have good sensitivity for these organisms.

To evaluate the different rapid screening tests for diagnosis of leptospirosis.

INTRODUCTION: Leptospirosis is an acute febrile disease, in tropical and sub-tropical regions of world. It has been under-reported in India, due to presence of non-specific symptoms and unavailability of appropriate laboratory diagnostic facilities in most part of the country. The diagnosis of leptospirosis is usually based on demonstration of antibodies by different serological tests. AIM: The present study aims to evaluate and compare commercially available rapid test. DESIGN AND SETTINGS: Case control study. MATERIALS AND METHODS: Three screening tests (Leptocheck WB, Latex agglutination test and SD leptospira) were compared by using 100 serum samples randomly obtained from clinical cases of Leptospirosis admitted in new civil hospital, Surat, Gujarat. All the patients with acute Leptospirosis were included in this 4-months pilot study from July 2011 to October 2011. All the results were compared with IgM ELISA and MAT for confirmation of diagnosis. RESULTS: Leptocheck WB, Latex agglutination test and SD leptospira had sensitivities of 84.8%, 84.8% and 72.7% & specificities of 37.3%, 71.2% and 71.2% respectively as compared to MAT. Leptocheck WB, Latex agglutination test and SD leptospira had sensitivities of 90.7%, 89.7% and 53.7% & specificities of 93.4%, 90.9% and 60% respectively as compared to IgM ELISA. CONCLUSION: Latex agglutination test kit and Leptocheck WB were found to be highly sensitive and specific. Neither of these tests require specialized equipment, and could be performed in peripheral laboratories with relatively little expertise.

Study of sexual behavior and prevalence of STIs/RTIs and HIV among female workers of textile industries in Surat city, Gujarat, India.

BACKGROUND: Surat city is vulnerable to transmission of sexually transmitted infections (STIs)/HIV due to its huge migratory population in diamond and textile industries. Females working in textile industries were not receiving focused intervention although they were at high risk of acquiring STIs/HIV. OBJECTIVE: The present study was conducted to know the prevalence of various STIs and HIV among the group of female textile workers in Surat city. The findings of the study will be helpful for policy decision makers to address the issues of a specific vulnerable group. MATERIALS AND METHODS: A total 257 female workers in various textile markets were enrolled in the present study. Data were collected by the help of a pre-tested questionnaire and analysis was done by using Microsoft Excel and the EPI Info software. RESULT: Overall prevalence of various STIs/RTIs (reproductive tract infections) was 16.73%, whereas HIV positivity was 1.17%. Bacterial vaginosis and candidiasis were the most common infections. CONCLUSION: Groups such as female textile workers need to be taken care of especially to enhance the HIV prevention and control activities in Surat city, which would help in breaking the chain of transmission.

Antibiotics for the treatment of leptospirosis: systematic review and meta-analysis of controlled trials.

Leptospirosis is a zoonotic disease prevalent mainly in developing countries and is associated with high case fatality. Antibiotics especially penicillin are the mainstay of treatment for a suspected or confirm case of leptospirosis but role of Penicillin has not been evaluated systematically in the light of current evidence. The present systematic review and meta-analysis is done to evaluate the role of antibiotics in the treatment of leptospirosis. Parallel group clinical trials involving use of penicillin in treatment of leptospirosis were searched from all available sources. Ten clinical trials were found suitable as per laid inclusion criteria eligible for present systematic review and five clinical trials were included in meta-analysis. Clinical trials included for meta-analysis were compared on the basis of mortality, fever days, numbers of patients presenting with oliguria, and number of patients undergoing need-based dialysis. Analysis was done by comprehensive meta-analysis software 2. Qualitative outcomes are summarized as odds ratio and quantitative outcomes are summarized as standard mean difference with 95% confidence interval. Random and fixed models are used for analysis. There was no significant difference between penicillin group and controlled group for mortality (Odds ratio 1.59 (95% CI 0.59-4.29), P = 0.35), fever days (std difference in mean = -0.223 (95% CI 0.394-0.995), P = 0.358), number of patients presenting with oliguria (Odds ratio 1.795 (95% CI 0.325-9.929), P = 0.502), and number of patients who underwent need based dialysis (Odds ratio 1.587 (95% CI 0.919-2.731), P = 0.098). Role of various antibiotics in treatment of leptospirosis is uncertain, and can be attributed to nonavailability of adequate clinical trials. Role of penicillin in the treatment of leptospirosis can be debated.

New Delhi Metallo-beta lactamase-1 containing enterobacteriaceae: origin, diagnosis, treatment and public health concern.

One of the biggest problems associated with the antibiotic therapy is resistance. Recently published studies have revealed that enterobacteriaceae, like E. coli and Klebsiella, isolated from several Indian centers are resistant to many antibiotics including some highly potent antibiotics like carbapenems. It has been proposed that this resistance is because of a carbapenemase enzyme called NDM-1 (New Delhi Metallo-betalactamase-1). This carbapenemase is class B carbapenemase also called metallolactamases as they require zinc at their active site. This enzyme is coded by a gene called bla-NDM-1 or gene NDM-1. NDM-1 containing enterobacteriaceae can be screened in laboratory by few techniques. Metallolactamase production can be detected by disk approximation test or Modified Hodge test and NDM-1 gene can be detected by polymerase chain reaction by the use of specific primer targeting the gene. Infections caused by such bacteria are associated with high morbidity and mortality. Two classes of antibiotics i.e., polymyxins (colistin) and glycylcyclines (tigecyclines), have shown in vitro activity against NDM-1 harboring enterobacteriaceae. The safety profile of both of these antibiotics is questionable. There is a need for active screening of microorganisms for NDM-1 and research should be directed towards the development of safe antibiotics for the treatment of these kinds of infections.

Characterization of bacterial etiologic agents of biofilm formation in medical devices in critical care setup.

Background. Biofilms contaminate catheters, ventilators, and medical implants; they act as a source of disease for humans, animals, and plants. Aim. Critical care units of any healthcare institute follow various interventional strategies with use of medical devices for the management of critical cases. Bacteria contaminate medical devices and form biofilms. Material and Methods. The study was carried out on 100 positive bacteriological cultures of medical devices which were inserted in hospitalized patients. The bacterial isolates were processed as per microtitre plate. All the isolates were subjected to antibiotic susceptibility testing by VITEK 2 compact automated systems. Results. Out of the total 100 bacterial isolates tested, 88 of them were biofilm formers. A 16-20-hour incubation period was found to be optimum for biofilm development. 85% isolates were multidrug resistants and different mechanisms of bacterial drug resistance like ESBL, carbapenemase, and MRSA were found among isolates. Conclusion. Availability of nutrition in the form of glucose enhances the biofilm formation by bacteria. Time and availability of glucose are important factors for assessment of biofilm progress. It is an alarm for those who are associated with invasive procedures and indwelling medical devices especially in patients with low immunity.

Neonatal sepsis: high antibiotic resistance of the bacterial pathogens in a neonatal intensive care unit of a tertiary care hospital.

OBJECTIVE: To study the bacterial pathogens causing neonatal sepsis and their sensitivity pattern so that guidelines can be prepared for empirical antibiotic therapy. MATERIALS AND METHODS: We conducted a prospective analysis of all the cases admitted to the neonatal intensive care unit (NICU) of a tertiary care hospital and studied the culture and sensitivity pattern of organisms isolated. The neonates who presented with signs and symptoms of septicemia, with/without pneumonia and/or meningitis were studied and a detailed record of the maturity, age at onset, sex, birth weight (weight on admission for home deliveries), symptoms and signs along with the maternal risk factors was made. The cases with suspect sepsis were screened using various screening markers. Blood culture was done in all the cases, while cerebrospinal fluid was analysed only in those indicated. Sensitivity of the isolated organism was tested by Kirby Bauer disc diffusion techniques and various drug resistance mechanisms were studied. RESULT: Out of the 190 neonates (M:F=1.22:1) admitted to the NICU, 60 (31.57%) shows blood culture positive. Ninety-five percent cases were due to early onset septicemia. Thirty one neonates had Gram negative, twenty seven had Gram positive septicemia and two had candidial infection. Seventy percent Gram-positive isolates were resistant to penicillin. Ninety percent Gram negative isolates were resistant to gentamycin and ampicillin. Carbapenem resistance mechanisms such as ESBL. CONCLUSION: There is an increasing trend of antibiotic resistance to the commonly used and available drugs. Continuous surveillance for antibiotic susceptibility should be done to look for resistance pattern.

Assessment of biofilm formation in device-associated clinical bacterial isolates in a tertiary level hospital.

BACKGROUND: Biofilm formation is a developmental process with intercellular signals that regulate growth. Biofilms contaminate catheters, ventilators, and medical implants; they act as a source of disease for humans, animals, and plants. AIM: In this study we have done quantitative assessment of biofilm formation in device-associated clinical bacterial isolates in response to various concentrations of glucose in tryptic soya broth and with different incubation time. MATERIALS AND METHODS: The study was carried out on 100 positive bacteriological cultures of medical devices, which were inserted in hospitalized patients. The bacterial isolates were processed as per microtitre plate method with tryptic soya broth alone and with varying concentrations of glucose and were observed in response to time. RESULTS: Majority of catheter cultures were positive. Out of the total 100 bacterial isolates tested, 88 of them were biofilm formers. Incubation period of 16-20 h was found to be optimum for biofilm development. CONCLUSIONS: Availability of nutrition in the form of glucose enhances the biofilm formation by bacteria. Biofilm formation depends on adherence of bacteria to various surfaces. Time and availability of glucose are important factors for assessment of biofilm progress.

Sexually transmitted infections and reproductive tract infections in female sex workers.

The present study was conducted in 300 female sex workers (FSWs) from Surat city in 2005-2006. Vaginal swabs, endocervical swabs and serum samples were collected from each of these FSWs. Vaginal samples were screened for bacterial vaginosis (BV), candidiasis and Trichomonas vaginalis . Endocervical swabs were screened for gonococcal infection. Serological tests for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg) and syphilis were performed. From a total of 300 FSWs, BV was detected in 40 (13.33%), trichomoniasis in six (2%), candidiasis in 31 (10.33%), HIV seropositivity in 35 (11.66%), HBsAg reactivity in 10 (3.33%) and rapid plasma regain (RPR) reactivity in 20 (6.66%) cases. RPR-positive serum samples were confirmed by the treponema pallidum hemaglutination test. Gonococcal infection was not found in any of the FSWs. Of the total of 35 HIV-positive patients, 20 patients had associated coinfection. Of the 35 HIV-seropositive FSWs, BV was detected in six (17.14%), candidiasis in six (17.14%), syphilis in five (14.28%) and HBsAg in two (5.71%). One (2.85%) HIV-positive FSW was positive for both candidiasis and syphilis.

Diagnosis of leptospirosis and comparison of ELISA and MAT techniques.

Leptospirosis is perhaps the most common, most wide spread yet under diagnosed zoonosis in the world, Inada et al identified the causal agent in Japan in 1916. Microscopic agglutination test (MAT) developed initially by Martin and Pettit (1918) is the reference method that was successively done after ELISA test to evaluate and compare and make a reliable diagnosis. Blood samples were collected from August 2004 to September 2004 from hospitalized patients of South Gujarat region who were clinically suspected cases of leptospirosis according to WHO case definition. In our setup we separated the sera and carried out ELISA for detection of IgM antibodies and rest of the sera were stored at -20 degrees C. As we do not have the facility for performing MAT test in our centre, we personally carried these sera to Chennai for performing the MAT and identified the serovars prevalent in South Gujarat region. Out of 30 samples tested 16 samples (53.3%) were positive by ELISA and 12 samples (40%) were negative by ELISA. By MAT, 17 samples (56.67%) were found positive and 13 samples (43.33%) were negative. 2 samples were borderline by ELISA and these turned out to be negative by MAT. Cosidering MATas the gold standard the sensitivity of IgM ELISA in this study was 88% and specificity 90.90%. We concluded that IgM ELISA is rapid test and its results are quite similar to MAT. The most common serovars isolated and identified are L. hebdomadis, L. pyrogenes, L. autumnalis and L. grippotyphosa in this part of the country.