Comparison of the Antimicrobial Efficacy of Various Contact Lens Solutions to Inhibit the Growth of Pseudomonas aeruginosa and Staphylococcus aureus.

Soft contact lenses provide perfect conditions for the breeding of pathogens. The study is a prospective, experimental study, conducted to know the antimicrobial ability of multipurpose contact lens solution against standard strains of Staphylococcus aureus and Pseudomonas aeruginosa by the stand-alone test. The test method is based on the procedures in the ISO 14729 standard primary stand-alone test. Three multipurpose contact lens care solutions commercially available in Mangalore markets, namely, Biotrue (Bausch & Lomb), Opti-Free Replenish (Alcon), and Aquasoft (Stericon Pharma), were tested for its antimicrobial effect in the microbiology lab at Kasturba Medical College, Mangalore. According to this study, the solutions named "Biotrue" and "Aquasoft" met the primary stand-alone and reached the 3log reduction and 5log reduction criteria in the manufacturer recommended time, respectively. No conclusion could be drawn for Opti-Free Replenish since the minimum recommended disinfection time was overnight, whereas it was noted for 6 hr only, and it should have been experimented further. The effectiveness of multipurpose solutions varies against different bacterial species. We have observed that the antimicrobial activity of different solutions varies with respect to time of incubation, and also there was a marked difference in the activity of some solutions against S. aureus and P. aeruginosa. So, it is necessary for the contact lens users to store their lenses in solutions for longer duration of hours. It is also recommended to use solutions that clear the ISO 14729 standards for better health conditions of the eye.

Taeniasis: An Unusual Presentation.

We report a case of 45-year-old male presenting with the history of nasal expulsion of segments of Taenia saginata. This route of expulsion is a rare occurrence. The report stresses this unusual presentation of taeniasis in endemic region.

Cutaneous Melioidosis.

Melioidosis is an emerging infection in India. It usually presents as pneumonia. Melioidosis presenting as cutaneous lesions is uncommon. We present a case of cutaneous melioidosis from Southern India. Cutaneous melioidosis can present as an ulcer, pustule or as crusted erythematous lesions. A 22-year-old gentleman known case of diabetes mellitus was admitted in our hospital with an ulcer over the left thigh. Discharge from the ulcer grew Burkholderia pseudomallei. He was successfully treated with ceftazidime. Melioidosis must be considered in the differential diagnosis of nodular or ulcerative cutaneous lesion in a diabetic patient.

Neurological melioidosis presenting as intracranial abscess.

Melioidosis is an emerging disease in our country caused by the bacteria Burkholderia pseudomallei. Melioidosis can virtually affect any organ. It has varying clinical presentations ranging from pneumonia to fatal sepsis. Central nervous system (CNS) involvement in melioidosis is rare. We present a case of CNS melioidosis from South India. As the incidence of diabetes is increasing in our country varying manifestations of melioidosis will be seen in routine clinical practice. Melioidosis should be considered in the differential diagnosis of intracranial abscess and meningoencephalitis, especially in diabetics.

Successful Treatment of Chromobacterium violaceum Sepsis in a South Indian Adult.

Infection due to Chromobacterium violaceum is rare. Diagnosis may be delayed since Chromobacterium sepsis may mimic melioidosis, especially in melioidosis-endemic areas. Management of Chromobacterium infection is challenging given the propensity of this pathogen to cause visceral abscesses, drug resistance, and relapse. Mortality rates are high despite treatment. We report a case of C. violaceum septicemia in an immunocompetent adult from south India, who was successfully treated with combination antibiotic therapy. Physicians in tropical and subtropical regions must be aware of C. violaceum infection as it can mimic melioidosis.

Anti-inflammatory effect of certain dihydroxy flavones and the mechanisms involved.

This study was designed to evaluate the anti-inflammatory action of four dihydroxy flavone derivatives; 3,3'- dihydroxy flavone, 5,6-dihydroxy flavone, 3,7-dihydroxy flavone and 6,3'-dihydroxy flavone and to further investigate the multiple cellular mechanisms underlying the anti-inflammatory effect of these compounds. The effect of dihydroxy flavones on acute inflammation was studied in rats employing carrageenan induced hind paw edema method. Further, the role of proinflammatory cytokines like TNF-α and IL-1ß, cyclooxygenases (COX-1 and COX-2), and free radicals in the action of flavone derivatives was investigated using in vitro assays. All the four dihydroxy flavone derivatives exhibited time and dose dependent inhibition of carrageenan induced paw edema. In addition, the investigated compounds inhibited both the isoforms of cyclooxygenase and cytokines in a concentration dependent manner and also suppressed the release of reactive oxygen species. The anti-inflammatory effect of dihydroxy flavones may be through mechanisms that involve an interaction with cyclooxygenases, cytokines and reactive oxygen species.

Emerging clinico-epidemiological trends in melioidosis: analysis of 95 cases from western coastal India.

OBJECTIVES: To study the clinico-epidemiological trends in melioidosis, an emerging disease in the western coastal region of India. METHODS: Data of 95 patients with melioidosis in the western coastal region of India were retrospectively analyzed with respect to monthly rainfall, risk factors, clinical presentations, and outcome. RESULTS: A strong linear correlation was seen between average monthly rainfall and the occurrence of cases (p=0.002). Mortality was seen only in patients with bacteremia (p<0.001). Nine (40.9%) patients with septic shock died (p<0.001). Age ≥ 40 years and diabetes mellitus were seen in 75.8% of cases, each. Pneumonia was the most common clinical presentation (32.6%), followed by musculoskeletal disease (20%), melioidotic lymphadenopathy (7.4%), and dental abscess (6.3%). Only 36.8% of patients had exposure to wet soil/surface water. CONCLUSIONS: Melioidosis is quite prevalent in the western coastal region of India, and is strongly associated with rainfall, age, and diabetes mellitus. Higher proportions of musculoskeletal, dental, and lymph node melioidosis were seen in this region as compared to endemic areas. Bacteremic melioidosis has a poorer prognosis than non-bacteremic melioidosis. The presence of septic shock is a strong predictor of mortality. Percutaneous inoculation may not be the main portal of entry for Burkholderia pseudomallei in this region.

Molecular characterization of antimicrobial resistance in non-typhoidal salmonellae associated with systemic manifestations from India.

Extended-spectrum cephalosporins and fluoroquinolones are essential antimicrobials for treating invasive salmonellosis, although emerging resistance to these antimicrobials is of growing concern, especially in India. Therefore, a study was conducted to characterize the antimicrobial susceptibility phenotypes, types of extended-spectrum ß-lactamase (ESBL) gene plasmids and serological relationships of 21 non-typhoidal Salmonella isolates from patients who attended three different hospitals in India from 2006 to 2008. The isolates were cultured from stool, blood and cerebrospinal fluid samples obtained from patients presenting with diarrhoea and accompanying systemic manifestations such as fever, vomiting and meningism. Non-typhoidal Salmonella isolates were investigated using serotyping and antimicrobial susceptibility testing. PCR screening was also performed to detect the ß-lactamase, qnr and aac(6')-Ib-cr genes and class 1 integrons. Sequencing for quinolone resistance mutations and plasmid replicon typing were also performed. An antimicrobial resistance microarray was used for preliminary screening and identification of bla(TEM) and bla(SHV) genes, and phenotypic testing for the presence of efflux pumps was also performed. Ten out of 21 isolates (48%) possessed the extended-spectrum cephalosporin resistance phenotype, with PCR amplification and sequencing revealing that isolates possessed TEM-1, SHV-12, DHA-1, OXA-1-like and CTX-M-15 ESBL genes. FII(s) plasmid replicons were detected in seven isolates (33%). The involvement of efflux pumps was detected in four isolates (19%) resistant to ciprofloxacin. It was concluded that SHV-12-carrying Salmonella serotype Agona may play an important role in ESBL-mediated resistance in non-typhoidal salmonellae in India. The very high percentage (48%) of ESBL-producing non-typhoidal salmonellae isolated from these patients represents a real and immediate challenge to the effective antimicrobial therapy of Salmonella infections associated with systemic manifestations. Continued surveillance for the presence of ESBL-producing (non-typhoidal) salmonellae in India is essential.

Antinociceptive effect of certain dihydroxy flavones in mice.

OBJECTIVE: This study was designed to evaluate the antinociceptive action of four dihydroxy flavone derivatives; 3,3'-dihydroxy flavone, 5,6-dihydroxy flavone, 3,7-dihydroxy flavone and 6,3'-dihydroxy flavone and to investigate the mechanisms involved. MATERIALS AND METHODS: The antinociceptive effect of dihydroxy flavones was investigated in mice employing acetic acid induced abdominal constrictions, formalin-induced nociception, and hot plate assay procedures. The effects following pretreatment with naloxone, yohimbine, ondansetron, haloperidol, bicuculline and glibenclamide were also studied by acetic acid assay to reveal the involvement of opioid, adrenergic, tryptaminergic, dopaminergic, GABAergic or potassium channels respectively in the antinociceptive action of these compounds. RESULTS: Dihydroxy flavone derivatives significantly reduced the number of abdominal constrictions in acetic acid assay. The paw licking response time during both the early and late phases of formalin-induced nociception was reduced in a dose dependent manner by dihydroxy flavones treatment. A significant increase in reaction time was also evident in hot plate assay after dihydroxy flavones treatment. The antinociceptive effect of dihydroxy flavones in the acetic acid assay was significantly attenuated by pretreatment with either naloxone or bicuculline. However, pretreatment of animals with yohimbine, ondansetron, haloperidol, or glibenclamide did not alter the response. CONCLUSION: All the four investigated dihydroxy flavones produced dose related antinociception through mechanisms that involve an interaction with opioid and GABAergic pathways.

Tuberculosis mimicked by melioidosis.

BACKGROUND: In regions endemic for tuberculosis (TB) such as India, presumptive anti-tuberculosis treatment is often prescribed. Melioidosis, caused by Burkholderia pseudomallei, is underdiagnosed in India, due to lack of awareness and a low index of suspicion. SETTING: A tertiary care hospital in south India. OBJECTIVE: To present our analysis of a series of 22 cases of suspected TB that was later confirmed as melioidosis. DESIGN: Twenty-two patients with culture-proven melioidosis, who were initially given empirical anti-tuberculosis treatment, were retrospectively analysed regarding clinical presentation, laboratory findings and epidemiological features, with a view to determining any significant discriminatory parameter/s that would help distinguish the two diseases. RESULTS: Eight cases mimicked pulmonary TB, five tubercular arthritis, three tubercular spondylitis, two tubercular lymphadenitis, two splenic abscess, and one each mimicked tubercular pericarditis and parotid abscess. Fever was the chief presenting complaint; all had high erythrocyte sedimentation rate (ESR) values (mean 111 mm +/- 23.7 SD); 15 (68.2%) had neutrophilic leuco-cytosis, 20 (90.9%) had diabetes mellitus. Subsequent to laboratory culture reports confirming melioidosis, appropriate treatment was instituted. CONCLUSION: Fever in a diabetic patient with high ESR and neutrophilic leucocytosis should raise suspicion of melioidosis while instituting presumptive anti-tuberculosis treatment in areas where both diseases are prevalent.

Epidemiological shift, seasonal variation and antimicrobial susceptibility patterns among enteric fever pathogens in South India.

Between January 2005 and December 2006, a higher incidence of paratyphoid fever (53.8%) compared to typhoid fever (44.9%) has been observed at a tertiary hospital in South India. A definite seasonal pattern of incidence is seen in paratyphoid fever (peak incidence during October-December, i.e., post monsoon period) but not in typhoid fever. Decreased fluoroquinolone susceptibility is much higher in S. Paratyphi A (98.8%) as compared to S. Typhi (46.5%). These findings are of importance in therapeutic decision making, development of vaccination strategies and implementing public health measures for disease control.

Melioidosis: an under-diagnosed entity in western coastal India: a clinico-microbiological analysis.

Clinico-microbiological analysis of a series of 25 patients with culture proven melioidosis was done. All patients came from the coastal regions of Kerala and Karnataka and presented between June 2005 to July 2006. They were analysed with respect to clinical presentation, occupation, epidemiology and microbiological features. No single presenting clinical feature was found to be typical of melioidosis. The disease was found to mimic a variety of conditions, including tuberculosis and malignancy. Burkholderia pseudomallei was isolated from blood, sputum, pus, urine, synovial, peritoneal and pericardial fluids. Diabetes mellitus was the most common predisposing factor and 80% of the cases presented during the Southwest monsoon (June to September). It is probable that melioidosis is highly prevalent in western coastal India and yet, greatly underestimated. Better awareness, both among clinicians and microbiologists, coupled with improved diagnostic methods to allow early diagnosis and hence early treatment, will significantly reduce the morbidity and mortality associated with this disease.

Primary meningoencephalitis by Naegleria fowleri: first reported case from Mangalore, South India.

A fatal case of primary amebic meningoencephalitis (PAM) in a 5-month-old infant is described. The disease may have been contracted during bathing. The source of water was from an artificial well. The clinical presentation, the isolation of the ameba from the cerebrospinal fluid, the poor response to amphotericin B, and the ultimate fatal outcome are all consistent with the diagnosis of PAM. On the basis of its ability to grow at temperatures above 30 degrees C, the morphology of the trophozoite, and the presence of flagellate forms, the ameba was identified as Naegleria fowleri. Pathogenic N. fowleri amebae were recovered from samples of water from the well. To our knowledge this case represents the second case of PAM in an infant in the absence of the history of swimming.

Evaluation of antimicrobial efficacy and release pattern of tetracycline and metronidazole using a local delivery system.

The present study compared the effectiveness of two antimicrobials, tetracycline and metronidazole, in reducing subgingival microorganisms in periodontal pockets using an ethyl cellulose strip as the delivery medium. The study involved 30 patients, with a minimum of 3 periodontal pockets with probing depths > 6 mm throughout the oral cavity. Patients were given supragingival scaling and then divided into 5 groups, depending on the length of time the medication was in place. Sites were marked for tetracycline, metronidazole, and placebo. Sites were wiped and isolated, and baseline microbiology samples were taken for Gram staining and culture methods. After treatment, subgingival microbiological samples were taken again. The ethyl cellulose strips were removed and analyzed for any remaining drug. Results showed that tetracycline and metronidazole can both be applied locally to periodontal sites using ethyl cellulose strips and markedly suppress the subgingival bacteria over a period of several days. The tetracycline showed a faster release; however, the metronidazole required a lesser concentration to achieve complete reduction of the subgingival flora.