Biomedical subjects
Publications and source records attributed to M D Mathur.
A case of cryptococcal meningitis in a neonate born to an HIV-negative women is described. The cryptococcal infection was proved using standard microbiological and antigen detection techniques. Although cryptococcal meningitis has previously been described in both immunocompromised and immunocompetent children, the present case represents youngest case of cryptococcosis reported to date.
BACKGROUND & OBJECTIVES: Treatment for gonorrhoea with fluoroquinolones is recommended. However, reduced susceptibility and treatment failure with fluoroquinolones has recently been reported. We undertook to study the antibiotic susceptibility pattern and the incidence of quinolone resistance in 36 consecutive isolates of Neisseria gonorrhoeae from April to November 2000. METHOD: Antibiotic susceptibility testing was performed by the Kirby Bauer disc diffusion technique and minimum inhibitory concentration (MIC) of ciprofloxacin was determined by the agar dilution method. Penicillinase producing N. gonorrhoeae (PPNG) were identified by using the nitrocefin disc method. RESULTS: Thirty six strains of N. gonorrhoeae obtained from 44 consecutive male patients (81.9%) were studied. By the disc diffusion method, only 3 (8.3%) of these isolates were found to be sensitive to ciprofloxacin. All isolates were sensitive to ceftriaxone while 23 (63.9%) were sensitive to tetracycline and 12 (33.3%) to penicillin. Four (11.1%) of the N. gonorrhoeae isolates were PPNG. Twenty seven (75%) isolates were found to be resistant to ciprofloxacin by MIC determination. INTERPRETATION & CONCLUSION: Incidence of ciprofloxacin resistance amongst N. gonorrhoeae isolates is on the rise in New Delhi. Periodic monitoring of antimicrobial susceptibility pattern of N. gonorrhoeae to antimicrobials other than quinolones is essential to prevent treatment failure in patients with gonorrhoea.
BACKGROUND & OBJECTIVES: Staphylococcus aureus is regarded as one of the most devastating human pathogens. Recently there have been reports of increasing incidence of S. aureus strains resistant to methicillin (MRSA). A surveillance study was undertaken to record the occurrence of MRSA and to study the prevalence of various phage groups in India. METHODS: A total of 7574 strains of S. aureus received during 1992-98 at the National Staphylococcal Phage Typing Centre, New Delhi were tested for methicillin resistance and susceptibility to phages of the International basic set. The occurrence of various phage groups between MRSA and MSSA (methicillin sensitive S. aureus) was compared. Results were analyzed according to the geographical origin and source of isolation of the strains. RESULTS: The dominant phage group from different parts of the country was phage group III. Prevalence of phage group III among the MRSA and MSSA isolates was 62.32 and 33.95 per cent respectively. The highest isolation of phage group III strains was from nasal carriers (45.94%), phage group II strains from skin (8.74%), phage group I strains from blood (19.44%) and nontypable strains from the environment (80.68%). An increase in the occurrence of MRSA has been noticed from 9.83 per cent in 1992 to 45.44 per cent in 1998. INTERPRETATION & CONCLUSION: S. aureus strains of phage group III are prevalent in India. The increase in occurrence of MRSA indicates an alarming spread of these organisms. A constant monitoring is important to take appropriate and timely measures to control their spread.
The present study was conducted over a period of 6 months to determine the Candida species causing candidemia in a neonatal intensive care unit and to analyse the risk factors associated with acquisition of significant fungemia. Speciation of the 19 isolated Candida spp was done by the standard techniques. Antimicrobial susceptibility of these isolates was determined by disc diffusion method against Amphotericin B, Fluconazole, Ketoconozole and 5-Flucytosine. Candida glabrata was the most common species involved (42.1%). Other species isolated were C. tropicalis (31.6%). Calbicans (21.1%) and C.parapsilosis (5.2%). All the isolates were sensitive to Amphotericin B. Resistance to other antigungal agents was seen only in C. globrata. Significant candidemia was seen in 14/19 (72.6%) of neonates. Risk factors found to be associated with significant candidemis in these neonates included intake of multiple broad-spectrum antibiotics (p<0.0001), use of total parenteral nutrition (p<0.045) and ventilators (p<0.0001).
Seventy one acute phase serum samples collected during an epidemic of dengue hemorrhagic fever were tested by immunoblot, a rapid immunochromatographic assay and Dengue Duo ELISA for presence of anti dengue IgM and IgG antibodies. A concordance of 81.7% and 76.1% was seen between the three tests for the detection of anti-dengue IgM antibodies and IgG antibodies respectively. The rapid test takes only five minutes, can be easily carried out in most laboratories and compares well with the ELISA and the immunoblot.
A recently developed international set of phages for typing methicillin resistant Staphylococcus aureus (MRSA) was used to characterize 300 strains of MRSA. The results were compared to that of phage typing with conventional phages and reverse phage typing. The use of MRSA phages increased the percentage typability from 17.6 per cent with the conventional set to 45.6 per cent with MRSA set and the strains were recognised as five distinct phage pattern viz., 622, M3/M5, MR8/MR12/MR25, 30/33/38 and mixed group. Phage type 622 was the most prevalent. On reverse phage typing 73 per cent strains could be typed with most strains belonging to one pattern i.e., 83A complex with limited discrimination. These 83A strains were highly resistant to erythromycin (98%) and tetracycline (93%). Our results show that MRSA phages are more useful in increasing typability and discrimination between the strains as compared to the conventional phages, reverse phage typing, and antibiogramtyping.
Otomycosis is a common fungal infection of the ear that is seen in the tropical and subtropical regions of the world. We performed mycologic analyses on debris and scraping samples from the external ear canals of 95 patients who had been clinically diagnosed with otomycosis. Seventy-one samples (74.7%) were positive for fungal growth; two of these samples contained two fungi, bringing the total number of isolates to 73. The most common pathogens were Aspergillus fumigatus (41.1% of all isolates), A niger (36.9%), and Candida albicans (8.2%).
A total of 100 yeasts and yeast like fungi isolates from clinical specimens were negative for oxidase production on Sabouraud dextrose agar. When grown on Columbia agar, chocolate agar, tryptose agar, Mueller-Hinton agar, brain heart infusion and a medium resembling Sabouraud's dextrose agar but with starch instead of dextrose, all the isolate of Candida albicans (55), C. guilliermondii (6), C. parapsilosis (14), C. tropicalis (6), C. pseudotropicalis (6) and Crytococcus neoformans (2) were positive for oxidase producation. Torulopsis glabrata (2), Saccharomyces cervisiae (2) and two out of seven isolates of C. krusei were negative for oxidase test.
Filariasis, a mosquito borne disease is endemic in many tropical countries and sub tropics including India. A 44 years old male presented with signs and symptoms of pleural effusion. Pleural fluid on examination was exdudative in nature and showed presence of microfilariae of Wuchereria bancrofti.
In India, cholera is endemic and affects usually the 3 to 5-year-old age group. There have been occasional reports in the neonatal period with Vibrio cholerae O139 Bengal. We report here a case of Vibrio cholerae O1 diarrhea in a 2-day-old, breastfed male, who had been delivered in the hospital and developed severe dehydration.
A patient was admitted with a history of cough, shortness of breath and fever. After investigations, he was found to have a left-sided pneumonia with pleural effusion. Culture of the patient's sputum, pleural fluid and blood revealed Salmonella senftenberg. The patient was started on antibiotics according to the sensitivity report and responded to therapy. The past history revealed attempt at suicide by the intake of corrosive acid, which caused an esophageal stricture. The leak of gastric contents into the mediastinum lead to the infection of the pleural cavity and pneumonia.
This study was carried out to determine the presence of HCV infection in cirrhotic patients and to compare their serologic profiles with detection of HCV RNA by RT-PCR. Liver function profiles were assessed and correlated with infection. Coinfection of HCV with HBV was studied in the Indian context Sera from 62 patients of biopsy confirmed cirrhosis and an equal number of asymptomatic controls were tested for HCV by two ELISA (third generation) kits and nested reverse transcription PCR using primers from the 5'NCR. Other tests included HBV serology (ELISA for HBsAg and anti-HBc) and liver function tests. Twenty-four (38.7%) cases were HCV infected, of which 17 (70.8%) had past exposure to HBV or were coinfected with HBV (either being chronically infected or carriers of HBV). There was no significant difference in the clinical and liver function profiles of HCV infected and uninfected cirrhotics. Similarly, no difference was observed in cases coinfected with both HCV and HBV compared with those infected with HCV alone. Although the difference between positivity of HCV RNA and of anti-HCV was not significant, HCV RNA and anti HCV were present together in only 7/62 (11.3%) cases. Thus testing for both antibody and HCV RNA would be more appropriate than either test alone. HBV infection was seen in about one-fourth of HCV infected cirrhotics. About one-fourth (25.8%) patients had non-B, non-C cirrhosis in whom testing for HCV variants and other recently characterized hepatitis viruses could be performed.
The aim of the study was evaluation of the utility of ELISA test using antigen A60 for rapid diagnosis of tuberculous menigitis (TBM) in paediatric age group. ELISA test based on mycrobacterial antigen A60 (Anda biological, France) was used to estimate specific IgM and IgG antibodies in the sera and CSF of 20 suspected cases of TBM which were selected on the basis of numerous parameters and were smear negative on concentrated smear of CSF. Sera of 20 Montoux negative healthy children was taken as control by detecting IgM and IgG antibodies to A60 antigen. Response to anti-tubercular treatment was observed in all the suspected cases of TBM. This study showed that specificity for diagnosis of TBM by detecting IgM and IgG antibodies in sera was 90% and 80% respectively. Sensitivity of the test by detecting IgM and IgG antibodies in sera was 85% and 80% respectively with positive predictive value of 89.47% for IgM antibody and 80% for IgG antibody. In CSF IgM and IgG antibodies were found in 75% and 60% cases respectively. Both were positive only in 60% of cases. It is concluded from this study that 80-85% cases of TBM in paediatric age group have eigher IgM or IgG antibodies in sera whereas 60-75% have antibodies in CSF.
A cross-sectional study was carried out on 321 serum samples to detect rubella and mumps antibodies in children below five years and to assess the optimum age for immunization against rubella and mumps. Seropositivity to rubella was 33.3 per cent in children below nine months, 16.9 per cent at 9-12 months and 25.5 per cent by two years. Mean antibody levels for rubella were low at nine months to one year and remained so till five years of age. Similarly, seropositivity for mumps was 53.3 per cent below nine months, 20.3 per cent at 9-12 months and 40 per cent by two years. Mean antibody levels for mumps were low between nine months to two years with a slight rise by five years. The findings suggest that a large majority of children are at risk by the age of nine months in our population and the measles, mumps and rubella (MMR) vaccination at this age may be most beneficial.
Primary TORCH infections (toxoplasmosis, rubella, cytomegalovirus and herpes simplex virus type 1 and 2) in the mother can lead to severe fetal anomalies or even fetal loss. A prospective study was designed to detect the seroprevalence of IgM antibodies to Toxoplasma gondii, rubella virus and cytomegalovirus and IgG antibodies to herpes simplex virus type 1 and 2. One hundred and twenty pregnant women presenting to the antenatal clinic of a tertiary health center were included in this study. Out of these 120 women 112 (93.4%) had evidence of one or more infections. Prevalence of IgG antibodies to HSV was 70%. Seropositivities for toxoplasmosis, rubella and CMV respectively were 11.6, 8.3 and 20.8%. Our data demonstrating high frequency of primary infections during pregnancy support the conclusion that routine prenatal TORCH screening is justified.
Methicillin resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen. Recently, there have been reports of increasing prevalence of MRSA in the community. We here report an outbreak of post operative wound sepsis by MRSA in the surgical ward of LN hospital. A surveillance study for MRSA was undertaken in the corresponding surgical ward, operation theater and OPD and the source of this outbreak was traced to an outdoor patient with community acquired MRSA infection. A total of 320 clinical and environmental samples were screened for MRSA. Seventy (21.8%) S. aureus were obtained, of which 12.8% were resistant to methicillin. 14% of the MRSA infections were from the community. Nasal carriage rates of MRSA in the screened hospital staff and admitted patients were 5.8% and 4.3% respectively. None of the environmental sites sampled yielded MRSA. A study of antibiogram revealed that all the MRSA were uniformly resistant to penicillin, erythromycin, gentamicin, tobramycin and tetracycline and sensitive to vancomycin. All isolates belonged to the same biotype and were nontypable by the standard set of phages.
OBJECTIVES: To determine the antibiotic susceptibility and plasmid profile of all Neisseria gonorrhoeae strains (PPNG and non-PPNG) isolated from May 1995 to March 1996 in Lok Nayak Hospital, New Delhi, India. METHODS: The agar plate dilution method was used to determine the minimum inhibitory concentration of five antimicrobials including norfloxacin and ceftriaxone which are most commonly used for treatment of gonorrhoea in Delhi. Isolates were screened for production of penicillinase by paper acidometric method and plasmid analysis of PPNG and non-PPNG was carried out by agarose gel electrophoresis. RESULTS: 50 consecutive isolates of N gonorrhoeae were studied, 8% among them were found to be PPNG while 28% were highly resistant to tetracycline (TRNG). Reduced susceptibility to norfloxacin (MIC > or = 1 microgram/ml) was observed in 12% of all isolates. All PPNG harboured the 4.4 MDa beta lactamase plasmid along with the 25.2 MDa tetracycline resistance plasmid. Norfloxacin resistance (MIC > or = 1 microgram/ml) was present in 28.5% of TRNG but only in 5.5% of the other gonococcal isolates. CONCLUSIONS: Results of this study clearly demonstrate that antibiotic resistant gonococcal strains of different clones are frequently found in New Delhi. Continued surveillance of susceptibility to currently prescribed antimicrobials and epidemiological studies are essential to prevent treatment failures leading to further spread of resistant strains.
A major outbreak of dengue hemorrhagic fever (DHF) affected more than 10,000 people in Delhi and neighboring areas in 1996. The outbreak started in September, peaked in October to November and lasted till early December. The clinical and laboratory data of 515 adult patients admitted to Lok Nayak Hospital, New Delhi were reviewed. Fever (100%), myalgias and malaise (96%), abdominal pain (10.2%) and vomiting (8.7%) were the prominent presenting features. Hemorrhagic manifestations were seen in all patients- a positive tourniquet test (21.2%), scattered petechial rash (23.07%), confluent rash (2.7%), epistaxis (38.4%), gum bleeds (28.06%) and hematemesis (22.86%) being the major bleeding manifestations. Hepatomegaly was observed in 96% of the patients. Laboratory investigations revealed thrombocytopenia, hemoconcentration and leukopenia. Serological confirmation with a microcapture ELISA technic was done in 143/515 patients. The mortality rate was 6.6% and, multiple bleeding manifestations, severe thrombocytopenia, hypoproteinemia and dengue shock syndrome (DSS) were associated with a higher mortality.