Screening for methicillin-resistant Staphylococcus aureus carriers among patients and health care workers of a tertiary care hospital in south India

A total of 200 subjects were screened for carriage of methicillin-resistant Staphylococcus aureus (MRSA) at different sites using oxacillin blood agar and mannitol salt agar with oxacillin. Overall carriage rate was 8.5%, with the highest rate in inpatients (15.6%) while the lowest was seen in health care workers (1.8%). The commonest site of colonization was the anterior nares. Oxacillin blood agar was found to be superior to mannitol salt agar with oxacillin for the isolation of MRSA. Male sex and prolonged hospital stay were found to be the major risk factors for MRSA colonization.

Pericardial effusion - an unusual manifestation of salmonellosis: a case report

Background

Nontyphoidal salmonellae are important food-borne pathogens that are usually associated with self-limiting gastroenteritis. Occurrence of extra-intestinal non-typhoidal salmonellosis in humans is increasing in many developing countries. The risk of extra-intestinal nontyphoidal salmonellosis is higher in patients with impaired cell mediated immunity, lympho-proliferative disorders and IL-12 deficiencies. Pericardial involvement is one of the rare manifestations accounting for <2% cases but the mortality is very high.

Case presentation

A 23 year old male was admitted in the medicine ward with complaints of fever, chest pain with non-productive cough, not associated with hemoptysis for past 3 weeks. He was a known case of Hodgkin's lymphoma and was treated with complete course of chemotherapy. Cardiovascular examination, chest X-ray and ECG findings suggested this to be a case of pericardial effusion. The causative agent of this purulent pericardial effusion was identified as Group B Salmonella following isolation from the pericardial fluid.

Detection of Entamoeba histolytica DNA in the saliva of amoebic liver abscess patients who received prior treatment with metronidazole

Saliva is an easily-accessible and a non-invasive clinical specimen alternate to blood and liver pus. An attempt was made to detect Entamoeba histolytica DNA released in the saliva of amoebic liver abscess (ALA) patients by applying 16S-like rRNA gene-based nested multiplex polymerase chain reaction (NM-PCR). The NM-PCR detected E. histolytica DNA in the saliva of eight (28.6%) of 28 ALA patients. The NM-PCR result was negative for E. histolytica DNA in the saliva of all the eight ALA patients who were tested prior to treatment with metronidazole but was positive in the saliva of eight (40%) of 20 ALA patient who were tested after therapy with metronidazole. The NM-PCR detected E. histolytica DNA in liver abscess pus of all 28 (100%) patients with ALA. The TechLab E. histolytica II enzyme-linked immunosorbent assay was positive for E. histolytica Gal/GalNAc lectin antigen in the liver abscess pus of 13 (46.4%) of the 28 ALA patients. The indirect haemagglutination (IHA) test was positive for anti-amoebic antibodies in the serum of 22 (78.6%) of the 28 ALA patients and 2 (5.7%) of 35 healthy controls. The present study, for the first time, demonstrates the release of E. histolytica DNA in the saliva of ALA patients by applying NM-PCR.

Mutation detection analysis of a region of 16S-like ribosomal RNA gene of Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii

BACKGROUND

The level of intra-species genetic variation in Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii populations in a localized geographic area, like Puducherry, India, remains unknown.

METHODS

In the present study the existence of genetic variation in the nested multiplex polymerase chain reaction (NM-PCR) amplified region of the 16S-like ribosomal RNA genes of E. histolytica, E. dispar and E. moshkovskii was investigated by riboprinting and single strand conformation polymorphism (SSCP) analysis.

RESULTS

We found that 70 stool specimens were positive for E. histolytica, 171 stool specimens were positive for E. dispar, and 37 stool specimens were positive for E. moshkovskii by NM-PCR. Ninety liver abscess pus specimens, 21 urine specimens, and 8 saliva specimens were positive for E. histolytica by NM-PCR. Riboprinting analysis detected a mutation in the PCR product of only one E. histolytica isolate from a stool specimen. However, SSCP analysis detected mutations in the PCR products of five E. histolytica isolates and three E. moshkovskii isolates from stool specimens, and one E. histolytica isolate from a saliva specimen. The mutations detected by riboprinting and SSCP analysis were confirmed by sequencing. All the nucleotide sequences showing mutations in this study have already been deposited into the NCBI GenBank database under accession numbers [GenBank: EF682200 to GenBank: EF682208].

CONCLUSION

The present study has revealed the subsistence of mutations in the ribosomal RNA genes of E. histolytica and E. moshkovskii, which points towards the existence of intra-species genetic variation in E. histolytica and E. moshkovskii isolates infecting humans.

A case report and review of the literature: ciprofloxacin resistant Salmonella enterica serovar Typhi in India

BACKGROUND

Enteric fever is a major public health problem in India. The current treatment of choice is the fluoroquinolones.

METHODS

The minimum inhibitory concentration (MIC) of ciprofloxacin was determined by E-test, HIMEDIA HiComb MIC test and agar dilution.

RESULTS

An isolate of Salmonella enterica serovar Typhi (S. Typhi) from a case of enteric fever gave a ciprofloxacin MIC of 64 microg/ml.

CONCLUSIONS

To our knowledge there have been no reports of such high-level resistance to ciprofloxacin in S. Typhi from southern India. HIMEDIA HiComb MIC test method is an alternative to the E-test. Ciprofloxacin resistant typhoid fever responds to treatment with ceftriaxone.

Detection of Cysticercus antigens and antibodies in cerebrospinal fluid of patients with chronic meningitis

Chronic meningitism is a less frequent manifestation of neurocysticercosis caused by Taenia solium cysticerci. In the present study we used Co-agglutination (Co-A), a simple and rapid slide agglutination test to detect specific Cysticercus antigen in the 67 cerebrospinal fluid (CSF) samples from patients with chronic meningitis of unknown etiology. The results were compared with that of ELISA for detection of antibodies. Among these samples four (5.97%) were positive for Cysticercus antigen by Co-A test and six (8.95%) were positive for antibodies by ELISA. Two samples were positive by both Co-A and ELISA, two were positive only by Co-A and four were positive only by ELISA. In the present study, although Cysticercus antigen and antibodies were present in CSF samples from eight (11.94%) patients, we cannot affirm that all the cases of chronic meningitis are due to cysticercosis, but for any case of chronic meningitis of unknown origin, it would be useful to consider the possibility of cysticercal meningitis.

A case of fatal acute pyogenic meningitis in a neonate caused by extended-spectrum beta-lactamase producing Salmonella group B

Salmonellosis constitutes an important public health problem throughout the world. In severe infections like meningitis and septicemia, antibiotic treatment is essential. Extended-spectrum cephalosporins are preferentially used to treat salmonellosis in children. Treatment failures due to in-vivo acquisition of an extended-spectrum beta-lactamase (ESBL) gene in nontyphoidal salmonellae are now well established. A 45-day-old male baby presented to the pediatric intensive care unit with a history of fever, poor feeding, two episodes of seizures of 3 days duration and recurrent apnoea. At admission, cerebrospinal fluid, stool and blood cultures were done and Salmonella enterica serovar Typhimurium was isolated from all the samples. The stool isolate was confirmed to be ESBL producing. The baby expired due to acute pyogenic meningitis.

Diagnosis of intestinal amoebiasis by using nested polymerase chain reaction-restriction fragment length polymorphism assay

BACKGROUND

Microscopy is unreliable to distinguish the pathogenic Entamoeba histolytica from the nonpathogenic Entamoeba dispar or Entamoeba moshkovskii in stool specimens.

METHODS

Nested polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was carried out to detect E. histolytica, E. dispar, and E. moshkovskii DNA in stool samples of 202 patients positive for E. histolytica, E. dispar, or E. moshkovskii by microscopy or culture and in 35 controls. The TechLab E. histolytica II enzyme-linked immunosorbent assay (ELISA) was performed to detect Gal/GalNAc lectin in 45 stool samples positive for E. histolytica, E. dispar, or E. moshkovskii by microscopy or culture. Rapid-indirect hemagglutination assay (IHA) was performed to detect serum antiamoebic antibodies in the 85 patients positive for E. histolytica, E. dispar, or E. moshkovskii in their stool specimens and in the 35 controls.

RESULTS

Nested PCR-RFLP was positive in 175 of 202 (86.6%) patient stool samples and was negative in all 35 negative control stool samples. ELISA was positive in 29 of 45 (64.4%) patient stool samples. The IHA test was positive in 19 of 85 (22.4%) patient serum samples and in one (2.8%) of the 35 control serum samples. Nested PCR-RFLP detected E. histolytica DNA in stool specimens of 12 (63.2%) of 19 seropositive patients, and in 31 (47%) of 66 seronegative patients. TechLab E. histolytica II ELISA detected E. histolytica antigen in stool specimens of six (54.5%) of 11 seropositive patients, and in 23 (67.6%) of 34 seronegative patients.

CONCLUSIONS

Nested PCR-RFLP was useful for the specific detection of E. histolytica, E. dispar, and E. moshkovskii in stool samples.

Helicobacter pylori eradication prevents recurrence after simple closure of perforated duodenal ulcer

BACKGROUND AND AIM

Evidence remains inconclusive as to whether eradication of Helicobacter pylori prevents ulcer relapse after simple closure of a perforated duodenal ulcer. This study was conducted to determine the effect of H. pylori eradication using a quadruple drug regimen along with a probiotic on ulcer recurrence after perforation closure.

METHODS

A total of 93 patients who had presented with perforated duodenal ulcer and had a simple closure of a duodenal perforation comprised the study group. Three months postoperatively, patients who were found to be positive for H. pylori infection (n = 60) were administered quadruple therapy consisting of omeprazole, clarithromycin, amoxicillin and colloidal bismuth subcitrate for 10 days along with the probiotic Lactobacillus sporogenes for 14 days. Diagnosis of H. pylori was carried out by urease test and histology. Patients were followed for 18 months. Recurrence of ulcer was analyzed for correlation with H. pylori status.

RESULTS

Of 60 patients who received H. pylori eradication therapy, 53 were available for subsequent follow up. H. pylori eradication was achieved in 43/53 (81.1%) patients. The ulcer recurrence in the eradicated group was 18.6% (8/43) compared to 70% (7/10) in the noneradicated group (P = 0.003).

CONCLUSION

Eradication of H. pylori significantly reduces the relapse of duodenal ulcer after simple closure of perforation. Anti H. pylori therapy must be recommended for all H. pylori positive patients after simple closure of a perforated duodenal ulcer.

Effect of KATP channel openers on myogenic and neurogenic responses in goat urinary bladder

Isolated goat detrusor muscle exhibited spontaneous contractility with an irregular amplitude and frequency. The spontaneity of detrusor muscle exhibited a mean amplitude as 11.99 +/- 0.83 mm and frequency as 1.37 +/- 0.16/min. KATP-channel openers namely, cromakalim or pinacidil (10(-7) - 10(-4) M) added cumulatively, elicited a concentration-related inhibition of both amplitude and rate of spontaneous contractions. The mean IC50 values for both amplitude and frequency for cromakalim were 3.3 x 10(-6) M and 2.9 x 10(-6) M, respectively; and for pinacidil were 2.0 x 10(-5) M and 1.5 x 10(-5) M, respectively. Glibenclamide, a KATP-channel blocker inhibited the cromakalim-induced concentration-related relaxation of spontaneous contractions with a significant increase in its mean IC50. ACh-induced concentration-related contractile response was inhibited in the presence of either cromakalim (10(-4) M) or pinacidil (10(-4) M). The mean EC50 value of ACh, in the presence of cromakalim (2.5 x 10(-3) M) was significantly increased as compared to the control (1.2 x 10(-6) M). In the presence of glibenclamide (10(-5) M) the inhibitory effect of cromakalim was significantly reduced with consequent decrease in the EC50 value (1.9 x 10(-5) M). Application of EFS (30 V and 5 ms) on goat urinary bladder strips at 1, 2, 5, 10, 20 and 30 Hz elicited frequency-related contractile responses. Both cromakalim and pinacidil caused a rightward shift in the frequency-related contractile response curve with significant increase in the mean EF25 and EF50 values, respectively. In the presence of glibenclamide (10(-4) M), the frequency-related inhibitory response curve was shifted to left with significant (P < 0.001) increase in the mean EF25, EF50 and EF75. The present results suggest that in the goat detrusor muscle, agonist and EFS-induced contractile responses were more potently inhibited by cromakalim than pinacidil with activation of glibenclamide sensitive KATP channels.

Cryptococcal meningoencephalitis diagnosed by blood culture

Increase in cryptococcal infection has been noticed after acquired immunodeficiency syndrome pandemic. Cryptococcus neoformans can be isolated from blood in the process of dissemination to brain. We report a case of cryptococcal fungaemia in a patient whose cerebrospinal fluid was negative for Cryptococcus neoformans. Retrospective analysis revealed human immunodeficiency virus seropositivity of the patient. He was treated with amphotericin B and fluconazole. Antiretroviral therapy was started, however, the patient succumbed to the infection.

Reverse passive haemagglutination (RPHA) test for detection of mycobacterial antigen in the cerebrospinal fluid for diagnosis of tubercular meningitis

BACKGROUND

Various serological techniques have been developed to detect antibodies and antigens in the cerebrospinal fluid (CSF) for diagnosis of tubercular meningitis. Most of the serological assays are ELISA based. Attempts have been made to use much simpler antigen detection techniques like the reverse passive haemagglutination (RPHA)which is simple and cost-effective.

AIMS

To evaluate the reverse passive haemagglutination (RPHA) test for detection of mycobacterial antigens in the CSF for diagnosis of tubercular meningitis.

METHODS

In the present study, we have made the use of polyclonal antiserum against heat killed whole Mycobacterium tuberculosis bacilli to sensitize the RBCs in RPHA to detect antigens in clinically suspected cases. A total of 46 cases (clinically suspected TBM 24, culture proven TBM 2, non- TBM cases 20) were included in the present study for detecting M. tuberculosis antigen in the CSF specimens.

RESULTS

Of the 26 test CSF specimens, 13 CSF specimens were positive by RPHA while 4 of the 20 control CSF specimens were also reactive. Two culture positive specimens included in the study were positive by RPHA. Of the 4 control CSF specimens positive by RPHA, 3 were culture proven cases of pneumococcal meningitis and 1 was a case of cryptococcal meningitis. The RPHA is found to be 50% sensitive and 80% specific; and showed a 76.4 % positive predictive value and a 55.2 % negative predictive value.

CONCLUSION

The RPHA is a simple test that could be used as an adjunct in diagnosing TBM. It does not require any special equipment or technically trained or skilled manpower. It is economical and can be afforded for use in community where TBM is more prevalent. Even though the present study showed a poor sensitivity and specificity, further identification, characterization and evaluation of better immuno-dominant and specific antigens or epitopes, and the usage of antibodies developed against such mycobacterial antigens might improve the sensitivity and specificity of this test.

Atypical mycobacterial infection among HIV seronegative patients in Pondicherry

BACKGROUND

The role of non-tuberculous mycobacteria (NTM) as aetiological agents in the causation of lung infections has seldom been systematically studied from India.

METHODS

Prospective study of Species identification from mycobacterial isolates.

RESULTS

A total of 22 isolates of mycobacteria were isolated from 635 samples of suspected tuberculosis in a two months period, of which 17 were Mycobacterium tuberculosis, three Mycobacterium kansasii and one each of Mycobacterium fortuitum and Mycobacterium gordonae.

CONCLUSIONS

This study highlights the importance of NTM as potential pathogens from both pulmonary and extrapulmonary sites in the Southern state of Pondicherry. Further studies on a larger scale are needed to delineate clearly the association of NTM and various infections, especially in immunocompromised patients.

Antifungal susceptibility of Cryptococcus neoformans to amphotericin B and fluconazole

Cryptococcus neoformans has emerged as an important opportunistic fungal pathogen in immunocompromised individuals. The therapeutic options of C. neoformans an opportunistic fungal pathogen include flucytosine, amphotericin B, and azole agents. However in the present scenario, emergence of resistance has been reported, hence this study was undertaken to evaluate antifungal susceptibility pattern of C. neoformans isolates from this southern part of India. Ten isolates of C. neoformans were tested against Amp B and fluconazole, of which 7 were susceptible to both and a single isolate of C. neoformans var gatti was resistant to both with MIC of 32mg/ml and 64mg/ml respectively.

Hypothyroid state reduces calcium channel function in 18-day pregnant rat uterus

Hypothyroidism significantly reduced the mean amplitude and increased the mean frequency of spontaneous rhythmic contractions in 18 day pregnant rat uterus. Nifedipine (10(-12)-10(-9) M) and diltiazem (10(-10)-10(-6) M) caused concentration related inhibition of the myogenic responses of the uterine strips obtained from both pregnant and hypothyroid state. However, nifedipine was less potent (IC50:2.11 x 10(-11) M) in pregnant hypothyroid state as compared to pregnant control (IC50: 3.1 x 10(-12) M). Similarly, diltiazem was less potent (IC50: 3.72 x 10(-9) M) in inhibiting the uterine spontaneous contractions in hypothyroid than in pregnant rat uterus (IC50:5.37 x 10(-10) M). A similar decrease in the sensitivity to nifedipine and diltiazem for reversal of K+ (100 mM)-induced tonic contraction and K(+)-stimulated 45Ca2+ influx was observed with these calcium channel antagonists in uterus obtained from hypothyroid pregnant rats compared to the controls. Nifedipine-sensitive influx of 45Ca(2+)-stimulated either by K+ (100 mM) or by Bay K8644 (1,4-dihydro-2,6-methyl-5-nitro-4-[2'-(trifluromethyl)phenyl]-3-pyridine carboxylic acid methyl ester) (10(-9) M) was significantly less in uterine strips from hypothyroid rats compared to controls. The results suggest that the inhibition of uterine rhythmic contractions may be attributable to a reduction in rat myometrial Ca2+ channel function in the hypothyroid state.

Guinea worm infection of urinary bladder manifesting as obstructive uropathy in rural Maharashtra

Guinea worm or Dracunculus medinensis is a well-documented helminthic infestation in many areas of Asia. In this report, we describe a rare case of guinea worm infestation in a 25-year-old woman who had developed symptoms of obstructive uropathy, in whom fragments of guinea worm were removed after urethral catheterization. To the best of our knowledge, adult guinea worm occurring in the urinary bladder has not been previously described.

Cysticercosis of the eye in South India--a case series

PURPOSE

To study the clinical presentation and treatment outcome of patients with ocular cysticercosis in southern India.

METHODS

This study included 10 patients who were diagnosed to have ocular or adnexal cysticercosis over a period of one year in Pondicherry, India. The clinical presentation, results of investigation and treatment outcome of the cases were analysed retrospectively.

RESULTS

Age of these patients ranged from 12 to 55 years. Four presented with loss of vision, two with a swelling in the eyelid, one with proptosis, one with diplopia and two with conjunctival involvement. ELISA for cysticercus antibodies in serum was positive in all cases. Albendazole and prednisolone were given for the treatment of these cases. Two patients responded well to treatment and were completely cured of the disease. There was partial improvement in 6 cases. Surgery in the form of excision was performed in two cases following a course of medical therapy. There was no significant change in visual acuity in eyes with intraocular cysticercosis following treatment.

CONCLUSION

Ultrasonography B scan and ELISA for anticysticercal antibodies help to establish the diagnosis of ocular cysticercosis. A combination of oral albendazole and corticosteroids is found to be effective in confirmed cases. Intraocular cysticercosis is associated with a poor prognosis for vision.

Arcanobacterium haemolyticum associated with pyothorax: case report

Arcanobacterium haemolyticum has an established role in the etiology of human pharyngitis. There are increasing reports of systemic infections caused by this organism. From India, we report the first case of Arcanobacterium haemolyticum causing pyothorax in an immunocompetent adolescent male patient. The probable mode of infection is also discussed. The role of A. hemolyticum as an animal pathogen needs further study.

Entamoeba moshkovskii and Entamoeba dispar-associated infections in pondicherry, India

The prevalence of Laredo strain--Entamoeba moshkovskii--and non-pathogenic E. dispar in patients attending the Jawaharlal Institute of Postgraduate Medical Education and Research hospital, Pondicherry, India, is reported here. E. moshkovskii is reported for the first time in India. The species are morphologically indistinguishable from pathogenic E. histolytica. Of 746 stool samples screened, 68 showing cyst or trophozoite stage of E. histolytica, E. dispar, or E. moshkovskii were subjected to small subunit (SSU) rRNA gene-based polymerase chain reaction, which revealed a higher prevalence of E. dispar (8.8%) and E. moshkovskii (2.2%) compared to E. histolytica (1.7%) in patients. Only 19% of the 68 stool samples, resembling E. histolytica by microscopy, were actually E. histolytica, implying that 81% of suspected infections were misdiagnosed and would have been treated unnecessarily with anti-amoebic drugs.

Cysticercus antibodies and antigens in serum from blood donors from Pondicherry, India

The aim of the present study was to screen the serum of blood donors, which are apparently healthy and residing in Pondicherry or its neighboring districts of Tamil Nadu State, for specific detection of Cysticercus antigens and antibodies. A total of 216 blood samples were collected from blood donors at the Central Blood Bank, JIPMER Hospital, Pondicherry, India during January and February 2004. Enzyme-linked immunosorbent assay (ELISA) was used to demonstrate anti-Cysticercus antibodies and the Co-agglutination (CoA) was used to detect antigen in sera. 14 (6.48 %) males were positive for either anti-Cysticercus antibodies or antigens. Of these eight sera were positive for anti-Cysticercus antibodies and six were positive for antigens. Results of the present study show that serum Cysticercus antigen detection may be a useful adjunct to antibody testing for seroprevalence studies of cysticercosis in the community. The present study is the first kind of study, carried out to determine both cysticercal antibodies as well as antigens in the serum samples collected from the healthy blood donors.

Seroprevalence of hepatitis B virus among Bhutanese refugees residing in Nepal

The carrier rate of HBsAg is about 6% in Bhutan and 1% in Nepal. Since outbreaks of viral hepatitis are also known, its high prevalence in a migrated community, if any, maybe a potential threat to the local people. The present study was conducted in Beldangi 2 Extension Camp, a Bhutanese refugee camp located in eastern Nepal to know the HBsAg carrier rate among the refugees. With the help of semi-structured questionnaires, 500 volunteers enrolled were interviewed for the risk factors for HBV transmission. Blood samples of 467 subjects were tested for HBsAg by an immunoassay based on immunochromatographic sandwich principle. Out of 467 samples 4 were positive for HBsAg a prevalence rate of 0.9%. HBsAg carrier rate was found to be low in Bhutanese refugees. From the questionnaires it was also found that they were not engaged in any practice that could increase the chances of HBV transmission. The study shows that the Bhutanese refugees in Nepal in this geographical area are not a threat to the local people as far as HBV transmission is concerned.

Detection of specific cysticercus antigen in the urine for diagnosis of neurocysticercosis

Neurocysticercosis (NCC) is an important zoonotic infection, and a significant cause of morbidity and mortality in India. Immunodiagnosis plays an important role in the early, rapid, and specific diagnosis of the condition. The aim of the present study was to detect specific cysticercal antigen excreted in the urine for the diagnosis of NCC. The objective was to develop and evaluate staphylococcal Co-agglutination (Co-A) test for the detection of urinary cysticercal antigen. In the present study, urine samples were collected from 9 cases of clinically suspected NCC, 8 cases of CT/MRI proven cases of NCC, 11 of non-cysticercal CNS infection controls, and 25 healthy control subjects. Polyclonal antisera raised in rabbits against porcine complete cysticercus homogenate antigen, was used in the Co-A test to detect cysticercal antigen. The Co-A detected excreted cysticercal antigen in the urine of five of nine (55.5%) clinically diagnosed NCC and in five of eight (62.5%), CT/MRI proven cases of NCC. A false positive reaction was observed with 1 of 11 (9%) of control urine specimens from non-cysticercal CNS infection controls. No false positivity was demonstrated with 25 urine samples collected from healthy controls. Results of the present study shows that the Co-A test can be employed as a moderately sensitive and specific test for detection of urinary antigen in the diagnosis of NCC in poorly equipped laboratories.

Dot-ELISA for the diagnosis of neurocysticercosis

The aim of the present study was to standardize and evaluate dot-Enzyme linked immunosorbent assay (Dot-ELISA), a simple and rapid test for the detection of cysticercus antibodies in the serum for the diagnosis of neurocysticercosis (NCC). The antigen used in the study was a complete homogenate of Cysticercus cellulosae cysts obtained from infected pigs and dotted on to nitrocellulose membrane. Test sera were collected from the patients of NCC, and control sera from patients with other diseases and healthy students and blood donors of the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital, Pondicherry, during a study period from 2001 to 2003. Dot-ELISA detected antibodies in 14 of 25 (56%) in clinically suspected cases of NCC, 13 of 23 (56.5%) in CT/MRI proven cases of NCC and 2 of 25 (8%) each in non-cysticercal CNS infection controls and healthy controls. The test showed a sensitivity of 56.25%, specificity of 92%, positive predictive value of 87.09%, and negative predictive value of 70.76%. Results of the present study shows that the Dot-ELISA as a simple test can be used in the field or poorly equipped laboratories for diagnosis of NCC .

Current pattern in antimicrobial susceptibility of Salmonella Typhi isolates in Pondicherry

Typhoid fever continues to remain a health problem as the causative organism Salmonella Typhi has developed resistance to many of the antibiotics used. This study was undertaken to determine the current pattern of resistance to antimicrobial agents and phage types of S.Typhi isolates obtained in a tertiary health care hospital in Pondicherry. Blood culture was done for 1296 suspected cases of enteric fever and 157 strains of S. Typhi were isolated. Sensitivity to ampicillin, chloramphenicol, gentamicin, ciprofloxacin and ceftriaxone was determined by disc diffusion, and the minimum inhibitory concentration (MIC) of ciprofloxacin determined. There were 61 multidrug resistant (MDR) isolates. The MIC of ciprofloxacin for 147 isolates was >0.5 mg/l; of these, 131 were resistant to nalidixic acid. Phage typing was done for 123 isolates and 115 were found to be of phage type E1, biotype 1. A decline in the number of MDR isolates was noted. Concurrently, there has been an increase in the number of isolates sensitive to all antibiotics except nalidixic acid, and all these isolates showed reduced susceptibility to ciprofloxacin. Nalidixic acid susceptibility could be a useful screening test for the detection of decreased susceptibility of S. Typhi to ciprofloxacin. The clinicians should be advised to use ceftriaxone selectively in cases showing non-responsiveness to ciprofloxacin.

Epidemiological study of kala-azar by direct agglutination test in two rural communities of eastern Nepal

We conducted a sero-epidemiological study of kala-azar in two endemic communities (Kasaini and Gidhaniya) situated in the Terai (plain) of eastern Nepal. Direct agglutination test (DAT) was used as a serological test for screening. Capillary blood samples were collected by filter paper method from 601 (96%) people of a total population of 628 in Kasaini and from 482 (94%) people of 515 in Gidhaniya. Positive DAT titres (1:2000) were found in 66 (6.09%) of 1083 sera tested. The male-female sero-prevalence ratio was 1.44:1 and the age group of 15 years and above was most affected. Among the bone marrow aspirates collected from 66 DAT seropositive cases, only 19 were positive for Leishmania donovani (LD bodies). Of the 47 DAT seropositive but LD bodies' negative cases, three were clinically active cases of kala-azar. Another nine developed clinical symptoms of kala-azar during 6 months follow-up and 23 were cases that had received prior treatment for kala-azar (within 1 year). The results of this study show the potential of the DAT on filter paper as a screening test for the surveillance of kala-azar at a community level.

Detection of slime production by coagulase-negative Staphylococcus: an assessment of two methods

The detection of slime can be helpful in determining the diagnostic value of coagulase-negative Staphylococcus (CNS). Here, we have made a comparative study of two phenotypic methods of slime production test from 28 clinically significant blood culture isolates of CNS. A total 16 out of 28 isolates (57.1%) were positive for slime by either of the tests, whereas only 5 out of 28 isolates (17.9%) were positive for slime by both the tests. The tube method detected slime in significantly more number of isolates than the spectrophotometric method (14 vs. 7; p<0.0483279). A weak correlation was found between the tube method and the spectrophotometric method (rs=0.2474). The tube test was found to be superior to the spectrophotometric test in terms of sensitivity, ease of performance and interpretation, and cost effectiveness.

A serological study of human cysticercosis in Pondicherry, South India

The present study was carried out to determine the extent of the problem of cysticercosis in Pondicherry by assessing the antibody response to porcine cysticercus antigen by the indirect haemagglutination (IHA) in people residing in and around Pondicherry and in patients clinically suspected to have cysticercosis. Serum samples were collected from 1442 persons apparently normal in respect to cysticercosis, 91 cases of clinically suspected cases of cysticercosis, and 100 normal healthy students and blood donors. These sera were tested for cysticercus antibodies by IHA test using whole porcine cysticercus antigen sensitised RBCs. An antibody titre of 1:64 and above by the IHA was considered to be diagnostic of cysticercosis. At this diagnostic titre, 88 (6.10 %) of 1442 apparently normal population sera were seropositive. Of these 88 seropositive subjects, 16 (18.18 %), 33 (37.5 %) and 32 (36.36 %) were in the age groups of 1-13 yrs, 14-40 years and above 40 years respectively. 52 (59.1%) were males and 36 (40.9 %) were females. Twenty (21.97%) out of 91 clinically suspected cases were found to be seropositive out of which 14 (70 %) were males and 6 (30 %) females. 4 cases were in the age group of 6-13 years, 14 cases in 14-40 years and 2 cases were in the age group of 40 years and more. Cysticercus antibodies were not detected in any of the sera from healthy peoples including students. A positive antibody response in 6.1 % of population residing in and around Pondicherry and in 21.97 % of patients clinically suspected cases of cysticercosis show that cysticercosis may be more common in Pondicherry than believed.

Comparison of latex agglutination and co-agglutination for the diagnosis and prognosis of cryptococcal meningitis

PURPOSE

To compare a commercially available Latex agglutination test and an in house co-agglutination test for the detection of cryptococcal antigen in cases of chronic meningitis.

METHODS

One hundred and fifty cerebrospinal fluid (CSF) samples from 150 cases of chronic meningitis were tested for the presence of Cryptococcus neoformans by modified India ink, culture and antigen detection by latex agglutination test (LAT) and co-agglutination (Co-A) test.

RESULTS

Thirty-nine cases were positive by one or more tests employed. Antigen detection in CSF by LAT and Co-A was found to be most sensitive (94.9%) while culture was the least (25.6%). Of the two antigen detection methods, Co-A was found to be more sensitive than the LAT, the difference being statistically significant. Initial CSF antigen titres did not have any prognostic significance.

CONCLUSIONS

Co-A for antigen detection is an inexpensive and useful adjunct to direct microscopy and culture for the diagnosis of cryptococcal meningitis, though its usefulness in prognosis needs to be evaluated further.

Subcutaneous zygomycosis caused by Basidiobolus ranarum - a case report

Subcutaneous zygomycosis caused by Basidiobolus ranarum is endemic in South India. The present report is of an agricultural labourer who presented with a painless swelling of the left thigh. Culture of the affected tissue yielded B. ranarum. The swelling completely subsided with oral potassium iodide.

Evaluation of formalin-acetone sedimentation in the concentration of stool for intestinal parasites

Formalin-acetone sedimentation was compared with the formalin-ether method for the concentration of stool for intestinal parasites. Of 80 stool specimens, 45 (56.25%) were positive for parasites by the formalin-acetone method. The figures for the two methods were formalin-ether 35 (43.75%) and for the direct lacto-phenol cotton blue wet mount method 17 (21.25%). There was no statistically significant difference in the parasite recovery rate between the two methods. Acetone is more stable, safer, and a cheaper fat solvent and promises to be a useful alternative to ether.

Thick stool smear wet mount examination: a new approach in stool microscopy

Microscopic examination of a wet mount of the stool has been the standard practice for the laboratory diagnosis of intestinal parasitic infections. Here we describe a novel method of stool microscopy of 80 stool samples, 31 (38.75%) were positive by the new thick stool smear wet mount method, whereas the corresponding figure for the conventional method using lacto-phenol cotton blue was 16 (20%). The difference was found to be statistically significant (P < 0.04 by McNemar's test). The thick stool smear wet mount procedure promises to be superior to the direct wet mount method in the detection of the intestinal parasites.

Post kala-azar dermal leishmaniasis (PKDL): a first case report from Nepal

Post kala-azar dermal leishmaniasis (PKDL) is a non-ulcerative lesion of the skin caused by Leishmania donovani, which is usually seen after completion of treatment of the kala-azar. The condition is yet to be reported from Nepal. We document and report for the first time a case of PKDL in Nepal.

Post-kala-azar dermal leishmaniasis (PKDL): the first case report from Nepal

Post-kala-azar dermal leishmaniasis (PKDL) is condition characterized by non-ulcerative lesions of the skin caused by Leishmania donovani that is usually seen after the completion of treatment of kala-azar (visceral leishmaniasis). We document the first case report of PKDL in Nepal.

Evaluation of lacto-phenol cotton blue (LPCB) for detection of Cryptosporidium, Cyclospora and Isospora in the wet mount preparation of stool

Lacto-phenol cotton blue (LPCB) was found to be a useful stain for detection of Cyclospora and Isospora oocysts in direct wet mounts of stool. LPCB stained these parasites blue, and differentiated their internal structures clearly, thereby facilitating detection and accurate identification of these parasites. However, the LPCB staining was not found useful in the identification of Cryptosporidium. The LPCB wet mount is recommended for use in the laboratories where acid-fast staining is not performed routinely, such as in a peripheral laboratory or in a rural health centre in the developing countries.