Oral changes in patients undergoing chemotherapy for breast cancer.

BACKGROUND: Breast cancer is one of the most common cancers in India. Most of the patients with breast cancer are treated with chemotherapy which has multiple oral complications. AIMS: The objectives of this study were to describe the occurrence of taste disturbances, xerostomia, oral mucositis, oral pigmentation, and candidal and salivary changes among patients receiving chemotherapy for breast cancer. METHODS: Fifty-two women with newly diagnosed breast cancer (without distant metastasis), eligible for adjuvant/neoadjuvant chemotherapy (cyclophosphamide and adriamycin, 4 cycles × 3 weeks), were included in this study. All the observations were noted before, during (after 6 weeks of starting chemotherapy), and after the completion of chemotherapy (after 12 weeks of starting chemotherapy). STATISTICAL ANALYSIS USED: Variables such as mucositis, salivary flow rate, salivary pH, and candidal carriage rate were compared at baseline, and at 1st and 2nd follow-ups using Wilcoxon signed-rank test (P value corrected for α for pair-wise comparisons). RESULTS: Mean unstimulated whole salivary flow rate reduced from 0.5 ml/min to 0.3 ml/min, and the mean colony-forming units of Candida reduced from 32.3 × 103 cells/ml to 13.1 × 103 cells/ml at the end of the study period. Xerostomia, taste disturbances, and oral mucosal pigmentation increased from 28.8% to 50%. CONCLUSIONS: There was a discernible change in oral mucosal, salivary, and candidal status during the course of the study.

CHARACTERIZATION OF CLOSTRIDIUM DIFFICILE ISOLATED FROM DIARRHEAL PATIENTS IN A TERTIARY-CARE HOSPITAL, KARNATAKA, SOUTH INDIA.

Increase in Clostridium difficile infection in tertiary-care hospitals in Karnataka, South India with a paucity of data on antibiotic susceptibility and genetic characteristics of the pathogen from this region of the country necessitated this study. From April 2012 to December 2014, 480 hospitalized antibiotic-associated diarrhea cases with a history of antibiotic treatment in the previous three weeks were enrolled. Sixteen percent of the samples were positive for C. difficile toxins A and B by rapid enzyme immunoassay, anaerobic culture and multiplex PCR. In 40 representative strains, minimum inhibitory concentrations (MICs) determined by E-test revealed that 39 strains were resistant to imipenem and moxifloxacin (MIC > 32 µg/ml), 38 to clindamycin (MIC > 256 µg/ml) and 19 to tetracycline (MIC > 4 µg/ml), while all 40 strains were susceptible to ampicillin (MIC < 2 µg/ml), ampicillin sulbactam (MIC < 8 µg/ml), metronidazole (MIC < 8 µg/ml) and vancomycin group (MIC < 2 µg/ml). Pulsed field gel-electrophoresis (PFGE) of 13 representative strains grouped them into three clusters: cluster A consisting of two strains having > 65% similarity, cluster B of 6 strains with 100% similarity (considered clonal) and 3 strains with > 85% similarity, and cluster C of 2 strains with 50% similarity. Clusters A and C contained unrelated strains having different antibiograms. Periodic monitoring of resistance profiles with epidemiological typing by PFGE should aid in interpretation of emerging drug resistant C. difficile clones.

Decreased susceptibility to antimicrobials among Shigella flexneri isolates in Manipal, South India--a 5 year hospital based study.

Shigellosis is endemic in many developing countries and an important cause of bloody diarrhea worldwide. Our study was undertaken as a continuation of our earlier study during 2001 - 2006.The aim of this study was to monitor changes in Shigella serogroups and resistance patterns to antimicrobials among Shigella isolates. Two thousand one hundred fecal samples were obtained from patients with diarrhea during June 2006-June 2011. Isolates were identified by standard microbiological techniques as Shigella spp and the disk diffusion method was used to determine antimicrobial susceptibility following CLSI guidelines. Of the 2,100 fecal samples, 77 (3.7%) contained Shigella spp, of which 73 (94.8%) were S. flexneri, 3 (3.9%) were S. sonnei and 1 (1.3%) was S. dysentriae type 1. S. boydii was not identified. One hundred percent resistance was noted against nalidixic acid. There were high levels of resistance to other antimicrobials: ampicillin (100%), Co-trimoxazole (89.6%), tetracycline (84.4%), ciprofloxacin (87%) and norfloxacin (83.1%). Most of the isolates were susceptible to ceftriaxone except for 2 isolates of S. flexneri. Antibiotic treatment of shigellosis is needed to prevent mortality. Increasing fluoroquinolone resistance leaves us dependent on third generation cephalosporins for treating shigellosis. Emerging resistance to these cephalosporins was seen in our study.

Identification of enteroaggregative Escherichia coli in infants with acute diarrhea based on biofilm production in Manipal, south India.

BACKGROUND: Enteroaggregative Escherichia coli (EAEC) is an emerging enteric pathogen that causes persistent diarrhea among infants, both in developing and industrialized countries. The EAEC strains adhere to epithelial cell surface, to the glass substratum and to each other in a distinctive stacked brick-formation. Thus, gold standard for identification of EAEC remains the HEp-2 cell adherence test, which is time consuming and requires specialized facilities. AIM: To evaluate the usefulness of quantitative biofilm assay to screen for EAEC from children with acute diarrhea. MATERIALS AND METHODS: A total of 100 E. coli strains were collected from acute diarrheal cases from December 2005 to November 2006. The strains were screened for biofilm production using microtiter plate method. The biofilm in the microtiter plate was visualized after staining with crystal violet and was quantified using enzyme immunosorbent assay plate reader. The Aggregative plasmid and Heat stable toxin genes were evaluated by a multiplex polymerase chain reaction. The strains were identified as EAEC with an optical density at 570 nm (OD570)>0.2. RESULTS: Of the total 100 Escherichia coli strains, 28 were positive by Polymerase Chain Reaction for two genes, AggR and EAST. Of the 28 PCR-positive strains screened for biofilm, 25 (89.2%) showed positive results by microtiter plate method. CONCLUSION: The quantitative biofilm assay using microtiter plate is convenient and economical and can be used as a screening method to screen E. coli isolates from acute diarrheal cases. The best use of this test is to screen large number of isolates quickly, and if positive this can be confirmed by multiplex PCR for AggR and EAST genes. This assay may contribute to demonstrating the true incidence of EAEC with and without AggR among clinically isolated E. coli strains, which can cause acute diarrhea.

Changing patterns of antimicrobial susceptibility of Shigella serotypes isolated from children with acute diarrhea in Manipal, South India, a 5 year study.

This study was carried out to determine the current pattern of Shigella serogroups and their antimicrobial resistance in children with acute gastroenteritis in Manipal, South India. A total of 1,200 stool samples were collected from April 2001 to May 2006 in children suffering from acute gastroenteritis attending the out-patient department of pediatrics at Kasturba Hospital, Manipal, South India. These samples were cultured for enteric pathogens. The isolates were confirmed to be Shigella by biochemical reactions and slide agglutination tests using specific antisera. Antimicrobial susceptibility was performed using an agar diffusion technique method following the National Committee for Clinical Laboratory Standard guidelines. Of 1,200 stool samples, 68 (5.6%) were positive for Shigella spp, 31 (45%) were Shigella flexneri followed by S. sonnei in 20 (31%), S. boydii in 10 (15%), and S. dysenteriae in 6 (8%). Of the 68 isolates, 58 (85.7%) showed resistance to various drugs and 47 (70%) were resistant to two or more drugs. Resistance to trimethoprim-sulfmethoxazole, tetracycline, nalidixic acid and ampicillin was observed in this study. All the strains were resistant to nalidixic acid (100%) but sensitive to cefotaxime and ceftriaxone.

Biochemical Identification of Enteroaggregative Escherichia Coli among Infants with Acute Diarrhea from Manipal, India.

BACKGROUND: The EAEC strains have been associated classically with persistent diarrhea which represents a disproportionate share of diarrheal mortality. EAEC strains have been shown to elicit damage to intestinal mucosa and growth retardation in infants. Detection of EAEC strains can make a significant contribution to public health in many areas. The use of biofilm assays as a screening method for EAEC from clinical isolates and multiplex PCR as confirmatory method may be useful. METHODS: We evaluated the usefulness of quantitative micro titer plate method for biofilm production and multiplex PCR to screen and confirm EAEC from a total of 100 E.coli strains from children below two years of age with acute diarrhea. RESULTS: E.coli strains were isolated from fecal specimens from 680 Diarrheic children who attended an out patient clinic or who were admitted to Kasturba Hospital and other peripheral hospitals in and around Manipal, Karnataka-South India. E coli isolates from 50 fecal specimens from infants without diarrhea (controls) who attended the same outpatient clinic and who belonged to the same group as the infants with diarrhea were also examined. CONCLUSION: Better diagnostic tools are needed to allow for more standardized laboratory testing on a regular basis. Improved diagnostic tools will help identify epidemiologic patterns of illness and guide treatment recommendations of EAEC illness.