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Biomedical subjects

Shriniwas

Publications and source records attributed to Shriniwas.

At least 19 recordsLinked to original sources

The housefly (Musca domestica) as a carrier of pathogenic microorganisms in a hospital environment.

Houseflies have long been regarded as potential carriers of microorganisms. Since pathogenic microorganisms are widespread in the hospital environment, there is abundant opportunity for flies to become contaminated and, in turn, to contaminate the patient environment. In the present study, an attempt was made to isolate and identify pathogenic bacteria, fungi and parasites from the housefly Musca domestica collected in the surgical ward of the All India Institute of Medical Sciences Hospital and also in a remote residential area located 5 km from the hospital. A total of 113 flies were collected: 65 from a surgical ward (test) and 48 from a residential area for comparison. Ten genera of bacteria were isolated from the test group of flies compared with nine from the control group. In primary isolations, it was observed that the load of bacteria carried by the test group of flies was significantly more (P less than 0.001) than for the control flies. Pseudomonas aeruginosa, Enterococcus faecalis and viridans streptococci were isolated only from the test flies. The isolation rate of Staphylococcus aureus was significantly higher (P less than 0.001) in test houseflies than in the control houseflies. There was no significant difference in isolation of parasitic ova and cysts from test and control houseflies. Candida spp. were isolated in almost equal numbers from both groups of houseflies, yet none of these was Candida albicans. Houseflies therefore may act as vectors of potentially pathogenic bacteria in a hospital environment.

Animals

Serum antibodies to verotoxin-producing Escherichia coli (VTEC) strains in patients with haemolytic uraemic syndrome.

Serological evidence of infection with verotoxin-producing Escherichia coli (VTEC) was sought in 28 patients suffering from haemolytic uraemic syndrome (HUS) and 25 age- and sex-matched controls. ELISA was used to detect anti-lipopolysaccharide (LPS) antibodies to E. coli strains O157, O111, O26 and NCTC 10418, a non-VTEC strain, and Shigella dysenteriae O1. Sera from 19 of the HUS patients but from none of the 25 controls had significant antibody levels to the verotoxin-producing bacteria. Sera from 13 patients reacted with only one LPS of the four verotoxin-producing bacteria; sera from six reacted with more than one LPS antigen but not with LPS of E. coli NCTC 10418. Paired sera taken 2-3 weeks apart were obtained from 20 HUS patients; 14 of these had high levels of antibody in the acute phase sample. Analysis of antibody levels in the convalescent sera showed that one patient had an increase, one was unchanged and 12 patients had a decrease in antibody to the verotoxin-producing bacteria.

Animals

Vector potential of hospital houseflies with special reference to Klebsiella species.

The vector potential of houseflies (Musca domestica) for Klebsiella spp. was investigated. Klebsiella spp. (mostly Klebsiella pneumoniae) were isolated from 36.7% of hospital flies and 28.1% of infected wounds of patients. Antibiograms of Klebsiella spp. showed that 82.0% of isolates from hospital flies and 96.3% from infected wounds were resistant to four or more commonly used antimicrobials. In contrast, from the control group, only 8.7% klebsiella isolates showed similar antimicrobial resistance pattern (P less than 0.001). Similar strains of Klebsiella spp. were encountered among patients and hospital houseflies. The results indicate that flies in the hospital environs are potential vectors of hospital resistant strains of Klebsiella spp.

Animals

Peritoneal tuberculosis: laparoscopic patterns and its diagnostic accuracy.

We report laparoscopic findings in 38 proven cases of peritoneal tuberculosis. The laparoscopic appearances can be classified into three types: thickened peritoneum with miliary yellowish white tubercles with or without adhesions (n = 25), only thickened peritoneum with or without adhesions (n = 8), and fibroadhesive pattern (n = 5). Biopsies were avoided from fibroadhesive lesions due to risk of complications. Visual diagnosis was accurate in 95% of patients. In comparison, in 27 (82%) of 33 patients, the examination enabled a histologic diagnosis to be made on the basis of typical granulomas. The combined use of guinea pig inoculation and culture isolated Mycobacterium tuberculosis in six (37.5%) of 16 patients. Mycobacteria were scarcely (3%) seen on histological sections. We conclude that, although target biopsy is an effective method of obtaining an early diagnosis of peritoneal tuberculosis, chemotherapy may be started on the basis of visual laparoscopic appearances alone.

Adult

Rapid diagnosis of tuberculous meningitis by polymerase chain reaction.

The polymerase chain reaction (PCR) in cerebrospinal fluid was compared with conventional bacteriology and an enzyme-linked immunosorbent assay (ELISA) for cerebrospinal fluid antibodies in the diagnosis of tuberculous meningitis (TBM). PCR was the most sensitive technique; it detected 15 (75%) of 20 cases of highly probable TBM (based on clinical features), 4 (57%) of 7 probable cases, and 3 (43%) of 7 possible cases. ELISA detected 11 (55%) of the highly probable cases and 2 each of the probable and possible cases. Culture was positive in only 4 of the highly probable cases. Among the controls (14 pyogenic meningitis, 3 aseptic meningitis, 34 other neurological disorders), 6 subjects tested early in the study (2 pyogenic meningitis, 4 other disorders) were PCR positive. Second DNA preparations from their stored cerebrospinal fluid samples were all PCR negative, suggesting that the false-positive results were due to cross-contamination. 18 PCR-positive TBM samples retested were all still PCR positive. The antibody ELISA was positive in 3 controls despite the use of a high cutoff value.

Bacteriological Techniques

Evaluation of a polymerase chain reaction for the diagnosis of tuberculosis.

A polymerase chain reaction for the specific detection of Mycobacterium tuberculosis has been developed and evaluated for clinical applicability. Primers were designed to amplify a 240 base pair region in the MPB 64 protein coding gene (nts 460-700). From among 15 different DNA templates tested (including 10 species of mycobacteria) PCR amplified the DNA from M. tuberculosis complex only, demonstrating its exquisite specificity. Sensitivity studies using serial ten-fold dilutions of M. tuberculosis bacilli determined the limit of detectability to be 10 organisms. A total of 143 clinical specimens were analysed. This consisted of 26 known non-tuberculous specimens (control group) and 117 specimens received at the Tuberculosis Diagnostic Service of AIIMS (test group). None of the specimens in the control group was positive by PCR. Out of 117 specimens in the test group, 19 were culture positive for mycobacteria and 17 of these isolates were identified as M. tuberculosis. All the specimens from which M. tuberculosis was grown were also PCR positive. The remaining two isolates were identified as mycobacteria other than M. tuberculosis and these two specimens were PCR negative. An additional 14 culture negative specimens were PCR positive yielding an overall M. tuberculosis positivity rate of 26.5% (31/117) compared to 14.5% (17/117) by culture. The superior sensitivity of PCR over culture was more evident in non-pulmonary cases where PCR picked up 10 cases in addition to three culture positives out of 69 specimens. On the other hand, out of 48 pulmonary specimens only four cases in addition to 14 culture positives were picked up by PCR.

Blotting, Southern

Nosocomial infections: cockroaches as possible vectors of drug-resistant Klebsiella.

The possibility that hospital cockroaches may act as vectors of drug-resistant Klebsiella spp. was investigated during Nov 1985 to April 1989, at the All India Institute of Medical Sciences (AIIMS) hospital. Klebsiella spp. (majority Klebsiella pneumoniae) were isolated from 28.3% of hospital cockroaches and 28.1% of infected wounds of patients. Most of Klebsiella isolates from patients (96.3%), and hospital cockroaches (85.9%) showed multiple drug resistance to four or more antimicrobials. Similar strains of Klebsiella spp. were encountered among patients and hospital cockroaches. These findings suggest that hospital cockroaches may act as vectors of drug-resistant Klebsiella spp. and may contribute to the epidemiology of nosocomial infections.

Animals

Gardnerella vaginalis: isolation and identification.

A total of 26 isolates of Gardnerella vaginalis were obtained from 248 patients attending the out patient department of Obstetrics and Gynaecology at A.I.I.M.S hospital, over a period of one year. The vaginal discharge of these patients was cultured on five different media in order to evaluate the best medium for the growth of G. vaginalis. Media containing human blood were found to be the most suitable, Human-Blood-Bilayer medium with Tween-80 being the best for the growth of the organism. A total of 12 biochemical tests were performed for the identification of each isolate. A short and rapid scheme for identification of the organism in a routine laboratory has been evolved.

Culture Media

Susceptibility of clinical isolates to cephalexin, cefazolin and cefotaxime.

Three hundred and seventeen recent clinical isolates were tested for in vitro susceptibility to the three cephalosporins available in India--cephalexin, cefazolin and cefotaxime by the Kirby--Bauer disc diffusion method. Cefazolin was the most effective cephalosporin against Gram positive cocci (71.8% sensitive) followed by cefotaxime (62.7%) and cephalexin (52.7%). Cefotaxime was very effective against commonly isolated Gram negative bacilli with only 10 (8.8%) isolates being resistant to it while 44 (39%) and 65 (57.5%) were resistant to cefazolin and cephalexin, respectively. All isolates of Pseudomonas aeruginosa were resistant to cephalexin and cefazolin and only 29 (32.6%) were sensitive to cefotaxime.

Cefazolin

Cockroaches as vectors of pathogenic bacteria.

One hundred and thirty two cockroaches of species Blattella germanica--96 from hospital ward (test group) and 36 from residential areas (control group) were caught during Nov. 1985 to Nov. 1986. A variety of pathogenic and non-pathogenic bacteria were isolated from test and control group of insects. Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus faecalis, and Micrococci were isolated only from the test group of cockroaches. A high percentage (98.95 per cent) of test cockroaches were found to be carriers of various microorganisms as compared to the control group (80.55 per cent), the difference being statistically significant (p less than 0.001). Quantitative analysis in this study revealed that higher number of microorganisms are carried by test group of insects in the hospital environment. This, thereby suggests that these insects can play an important role in the etiology of hospital acquired infections.

Animals

Soluble antigen fluorescent antibody (SAFA) test is not useful in childhood tuberculosis.

The diagnostic value of the soluble antigen fluorescent antibody (SAFA) test in childhood tuberculosis was studied in 117 children in the age group 0-12 years; 79 cases belonged to the study group, 23 children were non-tuberculous controls and 15 were tuberculin-negative healthy controls. The SAFA test was positive in 35 of 44 children with only pulmonary tuberculous lesions (80%) and in 21 of 35 children with other types of tuberculosis (60%). In the 23 non-tuberculous and 15 healthy controls it was positive in 11 cases (48%) and 7 cases (47%), respectively. The sensitivity, specificity and predictivity of the test were found to be 71%, 53% and 72%, respectively. The diagnostic value of the SAFA test was thus found to be low in childhood tuberculosis, especially in disseminated disease and tuberculous meningitis.

Child