Can Seminal IL-8 Level Be Used as a Marker of Leukocytospermia and Does It Have Any Correlation with Semen Parameters in Infertile Couples?

OBJECTIVES: Infection of male genital tract leads to leukocytospermia which may have a detrimental effect on semen quality. This study was conducted to evaluate whether seminal IL-8 level can be used as a marker of leukocytospermia and does it have any correlation with semen parameters in infertile couples? METHODS: This cross-sectional study was conducted in an infertility clinic of a tertiary care hospital including 150 male partners of infertile couples who underwent semen analysis (WHO laboratory manual for the examination and processing of human semen, 5th edn, World Health Organization, Geneva, p 271, 2010), semen culture sensitivity and seminal IL-8 levels. Independent t-test, Mann-Whitney U test and Chi-square test were applied for analysis. RESULTS: Mean seminal plasma IL-8 level of patients with leukocytospermia was significantly higher than patients without leukocytospermia (1143.67 ± 887.03 vs. 267.174 ± 242.29, p value < 0.001). Strong positive correlation was found between seminal plasma IL-8 levels and pus cells in the semen (r = 0.950, p < 0.001); AUC for seminal plasma IL-8 was 0.985 (CI 0.972-0.988), and a cutoff value of 399 pg/ml was determined to diagnose leukocytospermia. This value had high sensitivity (91.8%), specificity (94.5%), positive predictive value (94.4%) and diagnostic accuracy (93.2%) for detecting leukocytospermia. Seminal IL-8 levels correlated negatively with sperm motility (r = - 0.29, p < 0.001) and morphology (r = - 0.230, p < 0.01). CONCLUSION: Seminal plasma IL-8 levels were found to be almost five times higher in male partners with leukocytospermia than in non-leukocytospermia group, and it appears to be a promising tool to detect leukocytospermia. Seminal IL-8 level correlated negatively with semen parameters including sperm motility and morphology.

Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis.

OBJECTIVE: The aim of this study is to investigate etiological agents, patterns of antimicrobial resistance and predictors of mortality in culture proven neonatal sepsis. METHOD: This is a twenty-four month retrospective cohort study of infants with culture proven sepsis. Demographic data, type of isolates and its sensitivity pattern were recorded. Multidrug resistant gram-negative isolates were defined as resistance to any three of five antibiotic classes: extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones and piperacillin-tazobactam. RESULT: A total of 183 case with culture positive sepsis were identified. Early onset sepsis occurred in 59% of cases. The majority of isolates (56.2%) were gram-positive but the most common individual isolates were klebsiella spp. (31.1%), Staphylococcus aureus (24.5%) and coagulase-negative staphylococci (CONS) (22.9%). The pathogen mix in early-onset did not differ from late-onset sepsis. High rates of multidrug resistance were observed in klebsiella spp. (49.1%), Escherichia coli (50%), citrobacter spp (50%), acinetobacter spp. (28.5%), pseudomonas spp. (100%) isolates. Methicillin resistance prevailed in 16.6% of coagulase-negative staphylococci, 24.4% of Staphylococcus aureus and 62.5% of enterococcus spp. Multivariate analysis revealed invasive ventilation and early onset sepsis to be independently associated with increased risk of mortality in contrast to breast milk feeding which is associated with decreased risk of mortality. CONCLUSION: A high degree of antimicrobial resistance underscores the need to understand the pathogenesis of resistance, curtail the irrational prescription of antibiotics in neonates and the requirement for measures to prevent it in low-income and middle-income countries.

Role of prophylactic antibiotics in neonates born through meconium-stained amniotic fluid (MSAF)--a randomized controlled trial.

UNLABELLED: The objective of the study was to evaluate the effect of administering prophylactic antibiotics on the development of neonatal sepsis in term neonates born through meconium-stained amniotic fluid (MSAF). Two hundred and fifty eligible neonates were randomized to study group (Antibiotic group-receiving first-line antibiotics for 3 days) and control group (No Antibiotic group). Both groups were evaluated clinically and by laboratory parameters (sepsis screen and blood cultures) for development of sepsis. All neonates were monitored for respiratory, neurological, and other systemic complications and received supportive treatment according to standard management protocol of the unit. One hundred and twenty one neonates were randomized to 'Antibiotic' group and 129 to 'No Antibiotic' group. The overall incidence of suspect sepsis was 9.6 % in the study population with no significant difference between 'No Antibiotic' and 'Antibiotic' groups (10.8 vs. 8.2 %, p = 0.48, odds ratio (OR) 0.74, 95 % confidence interval (CI) 0.32-1.73). Incidence of culture-proven sepsis was also not significantly different between the two groups (5.42 vs. 4.13 %, p = 0.63, OR 0.75, 95 % CI 0.23-2.43). The incidence of mortality, meconium aspiration syndrome, and other complications was comparable amongst the two groups. CONCLUSION: Routine antibiotic prophylaxis in neonates born through MSAF did not reduce the incidence of sepsis in this study population. (Clinicaltrials.gov no. - NCT01290003).

Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study.

OBJECTIVE: To compare the fetomaternal outcome in women with spontaneous preterm labor, with or without bacterial vaginosis (BV). METHODS: One hundred and fifty-two pregnant patients presenting with spontaneous preterm labor between 28 and 35 weeks of gestation were screened for BV using Amsel's criteria and Nugent score, and were divided into two groups of 30 patients each, based on the BV positive or negative screen. Both the groups were followed till puerperium, and the fetal-maternal outcome was studied. The data was analyzed using Chi-square test and Man-Whitney test. RESULTS: BV was detected in 37 out of 152 women with preterm labor (24.34%). There was a significant increase in the incidence of respiratory distress (14% vs. 6%), requirement of intermittent positive pressure ventilation (IPPV) (14% vs. 5%), admission in neonatal intensive care unit (NICU) (15% vs. 6%), and duration of NICU stay >2 days (15% vs. 6%) in patients with BV. No significant difference was found in the mean birth weight, Apgar score, incidence of neonatal sepsis, perinatal mortality, and postpartum fever between the two groups. CONCLUSIONS: BV is a risk factor for increased neonatal morbidity. More research is needed for designing appropriate screening and treatment guidelines for prevention of adverse outcomes associated with BV.

Paratyphoid sepsis.

A large for gestational age male baby was born to a healthy young primigravida, on L-thyroxime, at 40 weeks by caesarean delivery in a tertiary care hospital. The baby had episodes of hypoglycemia during his immediate four postnatal days in the nursery that were successfully managed with intravenous glucose administration. The baby became unwell on day 5 and had a positive sepsis-screening test. Blood culture revealed a multidrug susceptible S. Paratyphi A strain, which he probably acquired on the first or second postnatal day from the contaminated expressed breast milk or the formula feed.

Rare serotype non-typhoidal Salmonella sepsis.

An 11-month female with a poor socio-economic status presented to a tertiary care paediatric hospital with complaints of fever of 4-5 days and diarrhoea of 20 days duration. The patient didn't respond to the prescribed antimicrobials namely--Norfloxacin and metronidazole. On admission she was diagnosed as persistent diarrhea with PEM grade III with sepsis. Stool examination and culture were negative for any pathogens, however blood culture yielded growth of Salmonella Virchow which was susceptible to most common antimicrobial agents excepting Trimethoprim Sulfamethoxazole. Salmonella Virchow is a common non-typhoidal Salmonellae causing bacteremia in the west, however this is the first report of bacteremia by S. virchow from India.

Antimicrobial resistance of enterococcal blood isolates at a pediatric care hospital in India.

Enterococci are one of the leading causes of nosocomial infections. In recent years, enterococci have become increasingly resistant to a wide range of antimicrobial agents. From April to October 2001, a study was conducted to speciate and determine the antimicrobial susceptibility of 50 isolates of enterococci from bacteremic children. These isolates were tested for antimicrobial susceptibility to the commonly used antibiotics. Screening for vancomycin resistance was done by the agar screen method, and the results were confirmed by determining the minimum inhibitory concentration (MIC) using the agar dilution method. It was observed that 33 isolates were Enterococcus faecium, followed by E. faecalis (10), E. durans (4), and E. dispar (3). Seventy-two percent of strains were resistant to ampicillin, 46% to amoxicillin + clavulanic acid, 72% to ciprofloxacin, 54% to doxycyclin, and 74% to erythromycin. Sixty-six percent of isolates showed high-level gentamicin resistance and 42% showed high-level streptomycin resistance. Four strains showed raised MIC to vancomycin (8 microg/ml). It was concluded that multidrug resistant E. faecium is emerging as an important agent of bacteremia in children.

Microbiological profile of neonatal septicemia in a pediatric care hospital in Delhi.

Septicemia continues to be an important cause of morbidity and mortality in the neonatal units and periodic review of cases to assess any changing trends in the infecting organisms and their antimicrobial susceptibility is important. Over a period of one year (July 2000 to June 2001), 632 samples of blood cultures were submitted to the bacteriology laboratory Microbiology, Lady Hardinge Medical College. These samples were investigated for microbial etiology and the isolates obtained were tested for their susceptibility to the commonly used antibiotics. Twenty per cent (125) cases were culture positive. Gram-negative bacteria were the predominant isolates (62%), commonest being Klebsiella pneumoniae (34%) followed by E. coli (17%), Acinetobacter spp. (9%) and Enterobacter aerogenes (2%). Gram-positive cocci were isolated in 20% cases, of which coagulase negative staphylococcus was the predominant isolate (11%) followed by Enterococcus spp. (5%) and S. aureus (4%). Candida spp. was isolated from 18% of cases. Resistance to commonly used antibiotics was seen in more than 35% of isolates. An alarming observation was the very high incidence of resistance to amoxycillin+clavulanic acid and ceftriaxone (>80%). All isolates showed highest susceptibility to ciprofloxacin.

Aminoglycoside resistance in enterococci isolated from paediatric septicaemia in a tertiary care hospital in north India.

BACKGROUND & OBJECTIVES: Enterococci are important nosocomial agents and serious infections caused by them are often treated with a combination of cell wall inhibitor and aminoglycoside. However, the presence of high level aminoglycoside resistance in these isolates makes this treatment combination ineffective. The prevalence of such isolates in a tertiary care set up has important diagnostic and therapeutic implications. The present study was carried out to find out the occurrence of high level aminoglycoside resistant isolates of enterococci in paediatric septicaemia cases in a tertiary care set up in north India. METHODS: Blood of paediatric cases with a clinical diagnosis of septicaemia was cultured to isolate and identify enterococci. Agar screen method was used to detect high level streptomycin and gentamicin resistance in these isolates. Vancomycin susceptibility of these isolates were determined as per the National Committee for Clinical Laboratory Standards (NCCLS) recommendations. RESULTS: Fifty one enterococcal strains were isolated from 21 neonates, nine infants and 21 children with a clinical diagnosis of septicaemia. Sixty eight per cent of these isolates had high level gentamicin resistance and forty three per cent had high level streptomycin resistance. All the isolates with high level streptomycin resistance also had high level gentamicin resistance. More than ninety five per cent of these isolates were sensitive to vancomycin. INTERPRETATION & CONCLUSION: The occurrence of high level gentamicin and high level streptomycin resistance in enterococcal isolates in our set up was high. This would require routine testing of the enterococcal isolates for high level aminoglycoside resistance. Alternative treatment regimes need to be sought, besides prudent use of antibiotics.

An outbreak of candidemia due to Candida tropicalis in a neonatal intensive care unit.

An outbreak of candidemia due to Candida tropicalis involving 16 neonates (gestational age 28-36 weeks) is reported. All infants had received hyperalimentation and at least one course of antibiotics. The commonest clinical manifestations included episodes of acute respiratory distress and lack of response to antibacterial antibiotic therapy. Candida tropicalis was recovered from blood in all the 16 infants and urine cultures were positive in 14 infants. Environmental sampling yielded C. tropicalis from one each of the blankets and mattresses used for neonates. Four of five urinary tract isolates and both environmental isolates genotyped by arbitrarily primed-PCR with several random primers were shown to belong to the same genotype.

Changing trends of Candida species in neonatal septicaemia in a tertiary North Indian hospital.

Four hundred and fifty four blood samples of clinically diagnosed septicemic neonates were collected over a period of six months from the neonatal ICU of Kalawati Saran Children Hospital, New Delhi. 144 samples were culture positive; out of which 50 (34.7%) were Candida isolates. 92% isolates were Candida tropicalis, 4% were C. albicans and C. kefyr each. The study emphasises the changing pattern of Candida species and their importance in blood stream infections in neonates.

Serum TNF-alpha and free radical scavengers in neonatal septicemia.

Tumor necrosis factor-alpha (TNF-alpha) and free radicals have been implicated in the pathogenesis of neonatal septicemia and its complications. This case control study was conducted between November 1996 to July 1997 to determine the levels of TNF-alpha and free radical scavengers viz. superoxide dismutase (SOD) and glutathione peroxidase (GPX) in the serum of 30 septic neonates and 20 healthy controls. Patients with neonatal sepsis registered significantly higher levels of TNF-alpha, SOD and GPX in comparison to controls (p < 0.05). The neonates with septic shock had five fold increase in TNF-alpha levels (2262 +/- 605.8 pg/ml) as compared to those without shock (738.8 +/- 728.8 pg/ml). There was no statistically significant difference in levels of antioxidant enzymes between neonates with shock and without shock. The levels of TNF-alpha and antioxidant enzymes were not affected by the type of organism isolated in blood culture.

Human giardiasis. A morphometric study of duodenal biopsy specimens in relation to the trophozoite count in the duodenal aspirate.

We present a morphometric analysis of findings from a histopathologic study of duodenal giardiasis in relation to the trophozoite count in the duodenal aspirate. Of 30 patients with giardiasis whose conditions were studied, a mean trophozoite count of 10(3)/mL or greater was found in 21, and a mean trophozoite count of less than 10(3)/mL was found in nine--these two types of trophozoite counts in these 30 patients represented the acute phase (group 1) and the clearance phase (group 2) of giardiasis, respectively. Group 1 patients had a low mean villus height that was significantly less than that found in the control subjects. Group 2 patients had a high mean crypt depth that was significantly greater than that found in the control subjects. Partial villus atrophy was seen in only seven of the group 1 patients, including five with villus epithelial cell lesions. Groups 1 and 2 showed minor differences of an inflammatory response that was significantly greater than that shown in the control subjects.

Human giardiasis: correlation of specific secretory IgA levels in duodenal fluid to the severity of disease and infestation by Giardia lamblia.

Giardia lamblia specific secretory immunoglobulin A (sIgA) levels in the duodenal fluid of adult giardiasis cases are reported for the first time. The sIgA levels in the study group were found to be significantly higher (p less than 0.01) than in the 20 age- and sex-matched controls comprising cases classified as non-ulcerative dyspepsia who did nor reveal any G. lamblia in their stools and the duodenal fluid. An inverse relationship between the clinical severity of giardiasis and the level of sIgA in the duodenal fluid was noted. Cases with a higher trophozoite load in duodenal aspirate tended to be associated with envanescent G. lamblia-specific antibodies.

Misonidazole reduces blood flow in two experimental murine tumours.

The effects of single doses of misonidazole (MISO) on blood flow and vascular volume in the SaFA and CaNT tumours and normal tissues of the mouse have been studied. MISO was administered in the dose range 250-1,000 mg kg-1 and blood flow measured at different times after MISO by the 86RbCl extraction technique. Vascular volume was assessed by the distribution of 51Cr-labelled red blood cells. MISO at doses of 500 mg kg-1 or greater decreased flow in both tumours by up to 60% within 2 h. Flow remained reduced for up to 24 h. Similar but less profound changes were seen in the skin, although flow had recovered by 24 h. Only slight changes were seen in muscle, and none in kidney. The apparent loss of flow in tumours seen after large single doses of MISO may have important implications for its use as a chemosensitizer.

Effect of anemia on tumor radiosensitivity under normo and hyperbaric conditions.

The effect of chronic anemia on tumor radiosensitivity in a murine tumor has been investigated. Anemia was induced by bilateral kidney irradiation given several months before tumor implantation. Anemic, anemic transfused, and normal non-anemic age-matched tumor bearing animals were irradiated with X rays (2 F/24 hr) either in air, air plus misonidazole, or under hyperbaric oxygen. The most resistant response was that of tumors grown in normal mice treated in air. Anemia produced an increase in radiosensitivity which was further enhanced by red blood cell replacement. The most sensitive overall response was seen in the anemic-transfused group treated with HBO.