Biomedical subjects
R Kanungo
Publications and source records attributed to R Kanungo.
Risk factors and associated problems in the management of infections with methicillin resistant Staphylococcus aureus.
PURPOSE: It is necessary to define the problem of methicillin resistant Staphylococcus aureus (MRSA) in every hospital to evolve control strategies. The objectives of this study were to determine factors influencing the persistence of MRSA in patients with hospital acquired infection and to identify alternate cost effective antibiotics. METHODS: A six month study was carried out for 50 patients with MRSA infection. Treatment modalities and risk factors were determined by a preset protocol. Minimum inhibitory concentration of commonly used antibiotics was determined. RESULTS: The risk factors were prolonged postoperative morbidity, prior antibiotic therapy and emergency admissions. Seventy percent of the isolates were from postoperative cases undergoing emergency surgeries. Isolation was highest during the second week of hospital stay. Emergency admissions had a significantly higher chance of early isolation. Prior treatment with multiple antibiotics in 38% was found to be another major risk factor. Ofloxacin was seen to be efficacious in a small percentage of cases. Rifampicin in combination with ofloxacin and clindamycin were found to be other good alternatives. Ofloxacin was found to be the cheapest and vancomycin the most expensive, for a full course of treatment. CONCLUSIONS: Minimizing risk factors and attention to alternate cost effective combination therapy may ease the problem of management of infections with MRSA.
Brain abscess due to Scedosporium apiospermum in a non immunocompromised child.
Scedosporium apiospermum is a filamentous fungi that commonly causes cutaneous infection. In certain circumstances, S. apiospermum can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited and the prognosis is poor. Early identification and treatment can decrease the mortality rate. Here we present a case of brain abscess with chronic suppurative otitis media, caused by S. apiospermum. This is the first such case report from Nepal. We could identify the organism only post mortem. We could not save the patient, probably due to delay in diagnosis.
Experimental evidence for the existence of 7H and for a specific structure of 8He.
Experimental search for the superheavy 7H isotope was performed in the reaction p(8He,pp)7H with the 8He beam at 61.3A MeV. The evidence for existence of the 7H state near the t+4n threshold was obtained. In the same experiment, the p(8He,t) reaction populating the ground and excited 2(+) state of 6He was investigated. The obtained results argue on a specific structure of the 8He ground state containing the 6He subsystem in the excited 2(+) state with a large weight.
Momentum distribution of 15B fragments from the breakup of 17B.
The two-neutron removal cross section (sigma(-2n)) and the longitudinal momentum distribution of 15B fragments from the breakup of 17B on 9Be were measured at 70A MeV. The distribution in the projectile rest frame is characterized by a FWHM of 80+/-10 MeV/c for 15B. The sigma(-2n) is found to be 0.22+/-0.05 b. A Glauber-type analysis of the data provides clear evidence of a two-neutron halo structure in 17B.
Nasopharyngeal carriage of resistant pneumococci in young South Indian infants.
Streptococcus pneumoniae is the leading bacterial cause of life-threatening infections in infants. Although antibiotic resistance affects management of pneumococcal infections, few data on patterns of resistance are available for India. We examined nasopharyngeal carriage of antibiotic-resistant pneumococci in 464 South Indian infants between 2 and 6 months. Newly acquired serotypes were screened for susceptibility to cotrimoxazole, erythromycin and penicillin using disk diffusion. Cumulative prevalence of pneumococcal carriage rose from 53.9% at 2 months to 70.2% at 6 months. The prevalence of strains that were not susceptible to penicillin, cotrimoxazole and erythromycin was 34, 81.1 and 37.2%, respectively. Carriage of erythromycin non-susceptible strains declined significantly between ages 4 months and 6 months (44.1 vs. 10.7%). More than 87% of the isolates screened were non-susceptible to > or = 1 antibiotic. Serogroups/types that were most frequently non-susceptible to 1 or more antibiotics were 6, 9, 14, 19 and 23. Less than 1% of the isolates were multi-drug resistant. Widespread use of antibiotics in South India has resulted in S. pneumoniae becoming non-susceptible to some commonly used antibiotics. Monitoring trends in antibiotic susceptibility and making antibiotics available only through prescription from a health care worker may slow the spread of resistant pneumococci and improve management of pneumococcal infections in South India.
Childhood bacterial meningitis in Pondicherry, South India.
OBJECTIVE: To identify causative bacteria from cerebrospinal fluid (CSF) of children with meningitis and analyse various clinical and laboratory parameters. METHODS: Over a 20 month period, September 1994 to April 1996, one hundred episodes of acute bacterial meningitis in children aged 1 month-12 years were studied in a tertiary urban hospital in South India. Organisms were isolated from the cerebrospinal fluid (CSF) in 35% of cases. Among infants and children, the two major pathogens were H. influenzae (17%) and S. pneumoniae (12%). RESULTS: The illness at presentation was mild in 13% and severe in 36% of cases. The association of subdural effusion in children with Salmonella Gp B meningitis merits attention. The overall case fatality rate was 25%. S. pneumoniae had a higher case fatality rate than Salmonella Gp B and H. influenzae (50% vs 17% vs 12%). All the three infants below 3 months of age with S. pneumoniae meningitis died. On analysis of selected clinical and laboratory features by discriminant analysis, CSF culture was the significant (P = 0.02) variable in relation to outcome. In pneumococcal meningitis, CSF WBC count was a highly significant variable in relation to outcome (Wilk's Lambda 0.15, F = 24.64, P = 0.0002). CONCLUSION: Prevention of infections due to H. influenzae and S. pneumoniae should be given higher priority.
Vitamin A supplementation at birth delays pneumococcal colonization in South Indian infants.
Nasopharyngeal colonization is a risk factor for pneumococcal disease, a leading cause of complications and death in infants. We assessed the impact of vitamin A supplementation in reducing pneumococcal colonization in infants from an area with endemic vitamin A deficiency. We recruited 464 2-mo-old infants from a rural area in South India. Infants were randomly assigned to receive two 7000-microg retinol equivalent doses of vitamin A (n = 239) or placebo (n = 225) orally at birth, and nasopharyngeal specimens were collected at ages 2, 4 and 6 mo. We studied the effect of vitamin A on culture-confirmed pneumococcal colonization and on the distribution of pneumococcal serotypes. Analyses were conducted by intention-to-treat. The risk of colonization among infants aged 4 mo who were not colonized by age 2 mo was significantly reduced in the vitamin A group compared with the placebo group [odds ratio 0.51 (0.28, 0.92), P = 0.02). The odds of colonization were 27% lower in the treatment group than in the placebo group [odds ratio 0.73 (0.48, 1.1), P = 0.13]. No differences were detected in the prevalence of invasive serotypes. The risk of colonization with penicillin-resistant isolates was 74% lower in the vitamin A group than in the placebo group at 2 mo of age. However, the prevalence of penicillin-resistant isolates was only 4%. Neonatal vitamin A supplementation may play a role in lowering morbidity rates associated with pneumococcal disease by delaying the age at which colonization occurs.
Pneumococcal nasopharyngeal colonization in young South Indian infants.
BACKGROUND: Streptococcus pneumoniae is the most frequent bacterial cause of morbidity and mortality in young children. Bacteria carried in the nasopharynx of healthy children reflect the prevalent strains circulating in the community. METHODS: We recruited 464 newborns from a rural area in South India with endemic vitamin A deficiency. Nasopharyngeal specimens were collected from each infant at ages 2, 4 and 6 months. RESULTS: Fifty-four percent of study infants were colonized by age 2 months, with 64.1 and 70.2% carriage prevalence at ages 4 and 6 months, respectively. The odds of carriage at 2 months were significantly increased in female infants, infants living in a household in which 20 or more cigarettes were smoked each day, infants whose mothers had less than 1 year of schooling and infants fed colostrum. At age 4 months infants having 2 or more siblings <5 years of age were at significantly increased risk of carriage. At age 6 months none of the potential risk factors examined achieved statistical significance, but maternal night blindness increased the risk of colonization 3-fold. The odds of carrying a PncCRM197 vaccine serotype were increased among infants born to mothers who experienced night blindness during pregnancy. The most prevalent serogroups/types during the first 6 months of life were 6, 9, 10, 11, 14, 15, 19, 23 and 33, accounting for 76.7% of all serotyped isolates. CONCLUSIONS: South Indian infants experience high rates of pneumococcal carriage during the first 6 months of life, which may partially explain their increased risk for pneumonia.
Pleural empyema due to group B Salmonella in a child with diarrhea.
Explore the source record for details and available documents.
Serotype distribution & antimicrobial resistance in Streptococcus pneumoniae causing invasive & other infections in south India.
BACKGROUND & OBJECTIVES: Streptococcus pneumoniae continues to be a major cause of morbidity and mortality in developing countries. The emerging resistance to some common antibiotics compounds the problem. There arises a need to monitor the resistance pattern and map serotype distribution in different geographic locations. The present study was undertaken to determine the serotype prevalence and antibiotic susceptibility of clinically significant S. pneumoniae isolated from a tertiary care hospital in south India. METHODS: A total of 150 clinical isolates from invasive and other clinically significant pneumococcal infections were serotyped and screened for susceptibility to commonly used antibiotics by standard and modified laboratory procedures. RESULTS: Majority (59.3%) of the isolates belonged to one or other of the serotypes 1, 6, 19, 5, 23 and 7. Serotype 1 was the commonest isolate from patients of meningitis and empyema followed by pneumonia. Nineteen isolates (12.6%) were nonvaccine type. Eleven (7.3%) isolates were relatively resistant to penicillin (minimum inhibitory concentration was between 0.1 and 1 microgram/ml) and 64 were resistant to one or more antibiotics. Resistance was distributed equally among the predominant serotypes. INTERPRETATION & CONCLUSION: The common serotypes responsible for significant infections were similar to those reported in some other studies from India, with minor variations. Resistance to cotrimoxazole and tetracycline was predominant followed by chloramphenicol. Low level resistance to penicillin was observed but no isolate had absolute resistance. This calls for monitoring of resistance and mapping of serotype distribution from various parts of India.
Perinephric abscess due to Aspergillus fumigatus.
Invasive aspergillosis is rare in healthy children. Severe systemic complications due to aspergillosis may be seen in AIDS patients with severe neutropenia and macrophage dysfunction.
Corneal perforation due to Acinetobacter junii: a case report.
Acinetobacter spp. is emerging as a common cause of nosocomial infections. Community acquired ocular infections due to Acinetobacter are rare. Only one case of perforation of cornea has been reported previously, where old nomenclature was used to describe the causal agent. We report a case of corneal perforation due to Acinetobacter junii for which a therapeutic penetrating keratoplasty was conducted and the patient eventually recovered.
Anthrax in Pondicherry, South India.
Explore the source record for details and available documents.
Throat carriage of pneumococci in healthy school children in the Union Territory of Pondicherry.
BACKGROUND & OBJECTIVES: Colonisation of Streptococcus pneumoniae in the throat is common among children the world over. Little is known about the relationship of nasopharyngeal carriage and invasive disease or the way it spreads within the households and close confines. There is a paucity of data on the colonization of Strep. pneumoniae in the throat of healthy children in India. To determine the prevalence of pneumococcal carriage in school children of urban and rural Pondicherry, a study was undertaken. METHODS: Throat swabs of healthy school-going children between 5-10 yr of age were examined for pneumococcal carriage, by standard bacteriological techniques. RESULTS: A prevalence rate of 24.3 per cent was noted. There was no difference in the carriage rate among the rural children when compared to urban children. No age, sex or geographical predilection of pneumococcal carriage was noted. A statistically significant seasonal variation, however, was seen. Carriage rate increased during the colder months and was found to be the highest in the months of March and November. INTERPRETATION & CONCLUSIONS: Strep. pneumoniae circulates in the community among healthy children. Carriage rate is influenced by seasonal variation.
Aeromonas caviae as a cause of cholecystitis.
Explore the source record for details and available documents.
Human anthrax in India: urgent need for effective prevention.
Anthrax is a zoonotic illness caused by Bacillus anthracis. Sporadic cases continue to be reported from many parts of the world. From India, both sporadic cases and outbreaks are being reported regularly. The Union Territory of Pondicherry (a former French colony) lies on the coast of Bay of Bengal, where the incidence of anthrax is on the rise with 28 cases being detected in the year 1999 and 2000 alone. So far, about 34 human cases have been encountered in this region. Recently, an increase in the number of anthrax cases has been noted in veterinary and human practice in this area. Most cases have occurred in agricultural labourers who gave history of handling animal meat or skin of infected animals. The meningitic form of the disease has a very bad prognosis. Patients with this form of disease died despite treatment with high dose penicillin. The typical bacilli were seen in the CSF in all cases of anthrax meningitis and was diagnostic of the condition. The cutaneous form of illness had a benign course and responded favourably to penicillin treatment. Awareness among clinicians and mandatory reporting of cases to public health departments along with public education will help control morbidity and mortality due to anthrax. Effective immunization of animals is the other important control measure for anthrax.