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EDITORIAL |
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State of Globe: Rabies: The lethality since antiquity! |
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Inder Maurya, Ketan Vagholkar, Bhavesh Patel, Mohsin Siddiqui, Shreshtha Tiwari, Premkumar Maurya DOI:10.4103/0974-777X.150880 PMID:25722611 |
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POINT OF VIEW |
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Survival or safety: Balancing act with Colistin |
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Saiprasad Patil, Kapil Zirpe, Dipnarayan Mukherjee, Anoop Hajare, Krishnaprasad Korukonda, Amit Bhargava DOI:10.4103/0974-777X.150881 PMID:25722612 |
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ORIGINAL ARTICLES |
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Evaluation of Geno Type MTBDRplus Line Probe Assay for Early Detection of Drug Resistance in Tuberculous Meningitis Patients in India |
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Renu Gupta, Rajeev Thakur, Prerna Gupta, Nupur Jalan, Suman Kushwaha, Meena Gupta, Piyush Gupta, Amitesh Aggarwal, Vikas Manchanda DOI:10.4103/0974-777X.150882 PMID:25722613Background: Molecular methods which allow for rapid and reliable detection of drug resistance have yet not been sufficiently evaluated for timely management of patients with tuberculous meningitis. Aims: We aimed to evaluate Geno Type MTBDRplus line probe assay for early detection of drug resistance in Mycobacterium tuberculosis isolates and CSF samples of confirmed tuberculous meningitis patients. Settings and Design: This was a multicentric prospective study carried out from July 2011 to December 2013 in tertiary care hospitals of Delhi. Materials and Methods: The assay was performed on 89 M. tuberculosis isolates and 31 direct CSF samples from microbiologically confirmed tuberculous meningitis patients. The sensitivity and specificity of this assay was calculated in comparison to drug susceptibility testing by BACTEC MGIT 960 system. Results: The sensitivity, specificity for detection of resistance to Isoniazid was 93%, 97% and to Rifampicin was 80%, 98.8%, respectively by this assay in comparison with the phenotypic drug susceptibility testing. The line probe assay could detect M. tuberculosis in 55% of CSF samples from patients with microbiologically confirmed tuberculous meningitis. Only 5/89 isolates (5.6%) were resistant to both Isoniazid and Rifampicin while 9/89 (10%) isolates were additionally resistant to Isoniazid. Resistance to any of the drugs, namely Isoniazid, Rifampicin, Streptomycin or Ethambutol, was seen in 24.7% of strains. Conclusion: The line probe assay has a good sensitivity and specificity for detection of drug resistance to Isoniazid and Rifampicin in M. tuberculosis culture isolates. However, this assay has limited role in detection of M. tuberculosis and drug resistance from direct samples with confirmed diagnosis of tuberculous meningitis. |
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Risk assessment for yellow fever in western and North-Western provinces of Zambia |
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Olusegun A Babaniyi, Peter Mwaba, David Mulenga, Mwaka Monze, Peter Songolo, Mazyanga L Mazaba-Liwewe, Idah Mweene-Ndumba, Freddie Masaninga, Elizabeth Chizema, Messeret Eshetu-Shibeshi, Costantine Malama, Emmanuel Rudatsikira, Seter Siziya DOI:10.4103/0974-777X.150884 PMID:25722614Background: North-Western and Western provinces of Zambia were reclassified as low-risk areas for yellow fever (YF). However, the current potential for YF transmission in these areas is unclear. Aims: To determine the current potential risk of YF infection. Setting and Design: A cross sectional study was conducted in North-Western and Western provinces of Zambia. Materials and Methods: Samples were tested for both YF virus-specific IgG and IgM antibodies by the ELISA and YF virus confirmation was done using Plaque Reduction Neutralization Test. The samples were also tested for IgG and IgM antibodies against other flaviviruses. Results: Out of the 3625 respondents who participated in the survey, 46.7% were males and 9.4% were aged less than 5 years. Overall, 58.1% of the participants slept under an impregnated insecticide-treated net and 20.6% reported indoor residual spraying of insecticides. A total of 616 (17.0%) samples were presumptive YF positive. The prevalence for YF was 0.3% for long-term infection and 0.2% for recent YF infection. None of the YF confirmed cases had received YF vaccine. Prevalence rates for other flaviviruses were 149 (4.1%) for Dengue, 370 (10.2%) for West Nile and 217 (6.0%) for Zika. Conclusion: There is evidence of past and recent infection of YF in both provinces. Hence, they are at a low risk for YF infection. Yellow fever vaccination should be included in the EPI program in the two provinces and strengthen surveillance with laboratory confirmation. |
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Influence of Pseudomonas aeruginosa on exacerbation in patients with bronchiectasis |
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Kiran Chawla, Shashidhar Vishwanath, K Manu Mohan, Bernaitis Lazer DOI:10.4103/0974-777X.150885 PMID:25722615Background: A majority of the studies done on the western population have shown that Pseudomonas aeruginosa causes many severe infections in patients with bronchiectasis as compared to other pathogens. There is scarcity of similar data from the Asian population. Materials and Methods: A prospective study was undertaken to identify the various pathogens isolated from the respiratory samples of 117 patients with bronchiectasis from south India and to compare the clinicomicrobiological profile of infections caused by P. aeruginosa and other respiratory pathogens. Results: The respiratory pathogens were isolated from 63 (53.8%) patients. P. aeruginosa was the most common isolate (46.0%) followed by Klebsiella pneumoniae (14.3%) and other pathogenic bacteria. Patients included in the P. aeruginosa group had a higher number of exacerbations (p: 0.008), greater number of hospital admissions (p: 0.007), a prolonged hospital stay (p: 0.03), and poor lung function, compared to the patients infected with the non-Pseudomonas group. Conclusion: It is necessary to investigate the etiology of respiratory tract infections among bronchiectasis patients followed by the prompt management of cases diagnosed with P. aeruginosa infections, so as to lower the morbidity and have a better prognosis. |
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Risk correlates of diarrhea in children under 5 years of age in slums of Bankura, West Bengal |
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Avisek Gupta, Gautam Sarker, Arup Jyoti Rout, Tanushree Mondal, Ranabir Pal DOI:10.4103/0974-777X.150887 PMID:25722616Background: Diarrheal diseases are an important cause of mortality and morbidity globally in children under 5 years of age. Objective: To find the prevalence and risk factors of diarrhea among children under 5 years. Materials and Methods: A population-based analytical cross-sectional study was conducted in the urban slums of Bankura, West Bengal on the prevalence of diarrhea and feeding practices, nutrition, and immunization among 152 children under 5 years (69 males and 83 females). Results: Overall prevalence of diarrhea was 22.36%; 21.73% males and 22.89% females were affected with diarrhea. There were 57.69% diarrhea cases in children of 7-12 months age group, followed by 25.71% in those of 13-24 months age group; with increasing age, the prevalence of diarrhea gradually decreased. Diarrhea was noted to be 20.33% in exclusively breastfed children and 31.57% in children who were breastfed for less than 6 months. In bottle-fed children, the frequency of diarrhea was 26.08%.The prevalence of diarrhea was 21.83% in completely immunized children and 30% in partially immunized children. Risk of diarrhea was 19.80% in normal participants and 27.45% in undernourished children. Conclusion: The present study identified a high prevalence of diarrhea in children under the age of 5 years. Findings of the study also revealed the demographic features, feeding practices, immunization practices, and nutritional status as risk factors of diarrhea, which can be tackled by effective education of the community. |
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Epidemiological characteristics of patients attending for rabies post-exposure prophylaxis at the infectious diseases hospital of Lucknow, India |
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Krishna Kumar Sahu, Manish K Manar, Shivandra K Singh, Harshwardhan Singh DOI:10.4103/0974-777X.150888 PMID:25722617Aims: The objective of the study was to assess epidemiological and anti-rabies vaccination status in animal bite patients attending the Infectious Diseases Hospital, Lucknow. Materials and Methods: A longitudinal survey was conducted in the Infectious Diseases Hospital of Lucknow from January to December 2013. During this duration a total of 390 patients presenting with animal bites were included. Results: A majority (63.3%) of patients were in the 16-59 years age group. 75% of patients had attended the IDH for rabies post-exposure prophylaxis (PEP) within 24 hours. The male to female ratio was 2.98:1. A majority (79.5%) of patients were injured by dogs. 9.0% patients were in close contact with rabies patient. On the basis of WHO classification, 4.2% of animal bite patients were placed in grade I, 88.2 in grade II and 7.6% in grade III. In 73.3% of patients wound were in lower limbs. Complete vaccination was found in 65.0% and the use of human rabies immune globulin was only in 11.1%. Conclusion: Outcome of an animal bite can be fatal. The only preventive/curative measure available is anti-rabies vaccination and the use of human rabies immune globulin, hence to assure 100% compliance for the same awareness campaign is required. |
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IMAGES IN NEUROSCIENCES |
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Cysticercal encephalitis presenting with a "Starry Sky" appearance on neuroimaging |
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Tushar B Patil, Ragini V Gulhane DOI:10.4103/0974-777X.150889 PMID:25722618A lady in her early forties was brought to our hospital in an unconscious state with history of generalized tonic-clonic seizures for last 6 h. She had multiple episodes of seizures in last 4 months, but did not receive any treatment. Relatives also gave a history of fever, headache, and vomiting for last 1 week. Her seizures were controlled with intravenous lorazepam and valproate. Clinical examination revealed a delirious patient with bilateral papilledema, brisk deep tendon reflexes, and extensor plantars. She had aspirated and had bilateral coarse crepitations on chest auscultation. Computed tomography (CT) of brain showed multiple small hyperdense calcific lesions extending throughout both the cerebral hemispheres leading to a "starry sky" appearance, suggestive of cysticercal encephalitis. The patient succumbed to progressive aspiration pneumonitis on the 6 th day after hospitalization. |
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MICROBIOLOGY REPORT |
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Typing and antibiogram of Vibrio cholerae isolates from a tertiary care hospital in Pune: A 3 year study |
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Meghna S Palewar, Archana C Choure, Swati Mudshingkar, Vaishali Dohe, Anju Kagal, Renu Bhardwaj, Abhishek Jaiswal, Banwarilal Sarkar DOI:10.4103/0974-777X.146375 PMID:25722619A retrospective analysis was done over a period of 3 years (January 2010- December 2012) in a tertiary care hospital, Pune, to note the changes in the prevalence and distribution of biotypes, serotypes, antibiotic susceptibility pattern and phage types of Vibrio cholerae isolates from clinical samples so as to be vigilant and curtail major outbreak in future. Vibrio cholerae isolates were obtained from 4.4% of the 1126 fecal specimens processed from cases of acute watery diarrhea. Majority of the isolates were identified as V. cholerae O1 biotype El Tor serotype Ogawa (98%); Phage 27 was the predominant type (77.5%). Majority of the cases were encountered during the months June-August (68%). Antibiogram over a period of 3 years showed that isolates were consistently resistant to Ampicillin (90%) and Furazolidone (88%). Low level of resistance was seen with Norfloxacin (8%), Gentamicin (8%) and Tetracycline (6%). All isolates were susceptible to Chloramphenicol. |
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CASE REPORTS |
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Diabetic foot gangrene patient with multi-drug resistant Pseudomonas putida infection in Karawaci District, Indonesia |
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Nata Pratama Hardjo Lugito, Cucu Nawangsih, Jevany Claudia Moksidy, Andree Kurniawan, Margaret Merlyn Tjiang DOI:10.4103/0974-777X.146378 PMID:25722620Pseudomonas putida is a rod-shaped, non fermenting Gram-negative organism frequently found in the environment that utilizes aerobic metabolism, previously thought to be of low pathogenicity. It had been reported as cause of skin and soft tissue infection, especially in immunocompromised patients. A female green grocer, 51 year-old came to internal medicine out-patient clinic with gangrene and osteomyelitis on her 1 st , 2 nd and 3 rd digit and wound on the sole of the right foot since 1 month prior. The patient had history of uncontrolled diabetes since a year ago. She was given ceftriaxone 2 grams b.i.d, metronidazole 500 mg t.i.d empirically and then amikacin 250 mg b.i.d, followed by amputation of the digits and wound debridement. The microorganism's culture from pus revealed multi drug resistant Pseudomonas putida. She recovered well after antibiotics and surgery. |
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Fungus or parasite or both: A diagnostic challenge |
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Tanmay S Panchabhai, Debabrata Bandyopadhyay, Melissa Piliang, Abhijit Duggal DOI:10.4103/0974-777X.146380 PMID:25722621Protothecosis is a rare opportunistic infection caused by achlorophilic algae Prototheca wickerhamii, mainly in immunocompromised hosts. Due to their morphologic appearance in routine culture media, they can often mimic yeast-like opportunistic pathogens such as Pneumocystis jirovecii. This can delay the identification of other culprit organisms. We present a fatal case of protothecosis in a 74-year-old immunosuppressed male with concomitant Pneumocystis jirovecii pneumonia (PJP). The presence of a coinfection along with resemblance in routine culture media and microbiological and histopathological staining can prove to be a diagnostic challenge and delay appropriate care of an immunosuppressed patient. |
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LETTERS TO EDITOR |
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Elizabethkingia meningoseptica outbreak in intensive care unit |
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Kiran Chawla, Anusha Gopinathan, Muralidhar Varma, Chiranjay Mukhopadhyay DOI:10.4103/0974-777X.150890 PMID:25722622 |
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Elbow Mycobacterium Tuberculosis in America |
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Ellen S Novatnack, Nicole M Protzman, Saman Kannangara, Michael F Busch DOI:10.4103/0974-777X.146374 PMID:25722623 |
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Comments on Investigating a Community Wide Outbreak of Hepatitis A in India |
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Amitav Banerjee DOI:10.4103/0974-777X.146379 PMID:25722624 |
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Antibiotic resistance profile of non-fermenting Gram-negative bacilli isolated from the blood cultures of cancer patients |
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Frincy K Baruah, Ahmed Nishat Hussain, Kausalya , Rajesh K Grover DOI:10.4103/0974-777X.150892 PMID:25722625 |
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Low rates of Hepatitis B and Human Immunodeficiency Virus coinfection in rural northern Tanzania |
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Jose D Debes, William M Stauffer, Mark Jacobson, David R Boulware DOI:10.4103/0974-777X.150893 PMID:25722626 |
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Candida endocarditis: The insidious killer |
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Vithiya Ganesan, Gowdara Kumar, Shunmuga Sundaram Ponnusamy DOI:10.4103/0974-777X.150894 PMID:25722627 |
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