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Chaudhary R, Tak V, Dutt A, Rodha MS, Meena SP, Badkur M, Kobade SP, Lodha M, Sharma N, Nag VL, Puranik A. Current Trends in the Management of Port-Site Infections: A Case Series and a Review of Published Work. Cureus 2023; 15:e40936. [PMID: 37496535 PMCID: PMC10368301 DOI: 10.7759/cureus.40936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Laparoscopic techniques have become standard for many surgeries, offering benefits such as quicker recovery and less pain. However, port-site infections (PSIs) can occur and pose challenges. PSIs can be early (within seven days) or delayed (after three to four weeks), with delayed PSIs often caused by non-tuberculous mycobacteria (NTMs). NTMs are difficult to treat and do not respond well to antibiotics, leading to prolonged and recurrent infections. Guidelines for PSI management are limited. This summary highlights a case series of 10 patients with PSIs, discussing their treatment experience and presenting a treatment algorithm used at our institute. Methods This is a retrospective study (2015-2020) on chronic port-site infections (PSIs) in laparoscopic surgeries. Data were collected on patient demographics, surgery type, prior treatment, and management at the institute. Results The study analyzed 10 patients with chronic PSIs following laparoscopic surgery between 2015 and 2020. Laparoscopic cholecystectomy was the most frequent index surgery. Three patients had a history of treatment with varying durations of anti-tubercular therapy, one of whom had completed anti-tubercular treatment prior to presentation. Complete surgical excision with histopathological examination and fungal, bacterial and mycobacterial cultures were performed. Seven of the 10 patients were treated with oral ciprofloxacin and clarithromycin combination therapy for three months, two were treated with culture-based antibiotics and one was treated with anti-tubercular therapy. All patients improved on treatment. The mean follow-up period was 52 ± 9.65 months, with no relapses being reported. Conclusion Port-site infections (PSIs) are troublesome complications of laparoscopic surgery that can erode the benefits of the procedure. Delayed PSIs caused by drug-resistant mycobacteria are difficult to treat. Improved sterilization methods and thorough microbiological work-up are crucial. Radical excision and prolonged oral antibiotics are effective treatments. Clinicians should avoid empirical antibiotic therapy to prevent antimicrobial resistance.
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Affiliation(s)
- Ramkaran Chaudhary
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Vibhor Tak
- Microbiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Akshat Dutt
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Mahaveer S Rodha
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Satya Prakash Meena
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Mayank Badkur
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Sarika P Kobade
- Microbiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Mahendra Lodha
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Naveen Sharma
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Vijaya L Nag
- Microbiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Ashok Puranik
- General Surgery, All India Institute of Medical Sciences, Guwahati, Guwahati, IND
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Muacevic A, Adler JR, Kumar D, Purohit A, Garg M, Kanchan DT, Dutt N, Kothari N, Bhaskar S, Elhence P, Bhatia P, Nag VL, Garg MK, Misra S, Pandey A, Dhawan A. Ultrastructural Changes in Autopsy Tissues of COVID-19 Patients. Cureus 2022; 14:e31932. [PMID: 36582579 PMCID: PMC9794915 DOI: 10.7759/cureus.31932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic resulted in substantial morbidity and mortality across the world. The prognosis was found to be poor in patients with co-morbidities such as diabetes, hypertension, interstitial lung disease, etc. Although biochemical studies were done in patient samples, no study has been reported from the Indian subcontinent about ultrastructural changes in the vital organs of COVID-19 patients. The present study was, therefore, conducted to understand the ultrastructural changes in the lung, liver, and brain of the deceased patients. METHODS The present study was conducted on samples obtained from reverse transcription-polymerase chain reaction (RT-PCR)-positive patients who were admitted to a tertiary care hospital in Western India. Core needle biopsies were done in eight fatal cases of COVID-19. The samples were taken from the lungs, liver, and brain and subjected to light microscopy, immunohistochemistry (IHC), and transmission electron microscopy (TEM). Clinical details and biochemical findings were also collected. Results: The study participants included seven males and one female. The presenting complaints included fever, breathlessness, and cough. Light microscopy revealed diffuse alveolar damage in the lungs. Further, a positive expression of SARS-CoV-2 nucleocapsid protein was observed in the pulmonary parenchyma of five patients. Also, the TEM microphotograph showed viral particles of size up to 80nm localized in alveolar epithelial cells. However, no viral particles were found in liver or brain samples. In the liver, macrovesicular steatosis and centrizonal congestion with loss of hepatocytes were observed in light microscopy. CONCLUSION This is the first study in the Indian population showing the in-situ presence of viral particles in core biopsies from fatal cases of COVID-19. As evident from the results, histology and ultrastructural changes in the lung correlated with the presence of viral particles. The study revealed a positive correlation between the damage in the lungs and the presence of viral particles.
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Jalandra R, Babu A, Dutt N, Chauhan NK, Bhatia P, Nag VL, Sharma P, Kumar D, Banerjee M, Joshi A. Co-infections in Hospitalized COVID-19 Patients- A Prospective Observational Study. Cureus 2022; 14:e30608. [DOI: 10.7759/cureus.30608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
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Vishwajeet V, Purohit A, Kumar D, Vijayvergia P, Tripathi S, Kanchan T, Kothari N, Dutt N, Elhence PA, Bhatia PK, Nag VL, Garg MK, Misra S. Evaluation of Liver Histopathological Findings of Coronavirus Disease 2019 by Minimally Invasive Autopsies. J Clin Exp Hepatol 2022; 12:390-397. [PMID: 34312578 PMCID: PMC8294712 DOI: 10.1016/j.jceh.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
AIM The severe acute respiratory syndrome coronavirus 2 outbreak resulted in severe health impact with the loss of many lives across the world. Pulmonary parenchyma suffers the most from the brunt of the infection. However, evidence suggested a systemic involvement during the course of illness. Information on morphological changes of the liver is sparse in the literature. We aimed to evaluate the pathological findings in the liver by minimally invasive autopsies. METHODS Postmortem core biopsies of the liver obtained from patients who succumbed to coronavirus disease 2019 disease were studied. Demographic findings, comorbidities, and relevant laboratory tests were collected. Detailed histopathological changes were assessed. RESULTS Liver function tests were available in 40 cases, and it was deranged in 80% cases. A spectrum of histological changes was observed. Macrovesicular steatosis and nonspecific portal inflammation of mild degree were the common morphological changes. Features suggestive of vascular alteration were noted in more than half of the cases. These included increased portal vein branches, irregular luminal dilation, and herniation of portal veins into the periportal hepatocytes. In addition, we observed morphological changes attributed to terminal shock-related changes. CONCLUSION The present study results highlight that liver parenchyma changes may be related to multiple pathogenic mechanisms. The presence of vascular alteration in portal tracts suggests derangement of hepatic vasculature related to systemic hypercoagulable state induced by the viral infection. It remains to be established if the histological changes are related to direct viral insult or to the systemic response caused by the viral attack.
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Key Words
- ACE2, Angiotensin-Converting Enzyme 2
- ALT, Alanine Aminotransferase
- ARDS, Adult Respiratory Distress syndrome
- AST, Aspartate Aminotransferase
- CBC, Complete Blood Count
- CK-MB, Creatine Kinase-MB
- COVID-19
- COVID-19, Coronavirus Disease 2019
- ISH, In situ Hybridization
- LDH, Lactate Dehydrogenase
- LFTs, Liver Function Tests
- PCR, Polymerase Chain Reaction
- RNA, Ribonucleic Acid
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- abnormal liver chemistries
- autopsy
- liver pathology
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Affiliation(s)
- Vikarn Vishwajeet
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Abhishek Purohit
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Deepak Kumar
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Parag Vijayvergia
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Swapnil Tripathi
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Nikhil Kothari
- Department of Anaesthesia, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Poonam A. Elhence
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Pradeep K. Bhatia
- Department of Anaesthesia, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Vijaya L. Nag
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Mahendra K. Garg
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
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Kalita JM, Aggarwal A, Yedale K, Gadepalli R, Nag VL. A 5-year study of dengue seropositivity among suspected cases attending a teaching hospital of North-Western region of India. J Med Virol 2021; 93:3338-3343. [PMID: 33038014 DOI: 10.1002/jmv.26592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 11/08/2022]
Abstract
Dengue virus infection is estimated to cause infection in approximately 390 million people globally each year, of which 96 million develop clinical disease. Dengue serotype 2 (DEN-2) is the most prevalent serotype over the past 50 years in India, but serotypes 3 and 4 have appeared in some epidemics as well. A retrospective study was conducted in a teaching hospital, western India, between January 2014 and December 2018. The records of dengue serological test were analyzed. In total, 40 randomly selected nonstructural protein 1 (NS1) antigen-positive samples were analyzed by a reverse transcription-polymerase chain reaction. The demographic data, that is, age and sex, along with geographic location and platelet count level, were recorded from the Serology laboratory register and Hospital Information System. In total, 14.85% (735/4948) samples tested positive for dengue serology. Most of the laboratory-confirmed dengue cases, 34.97% (257/735), were observed in the 21-30 years of age group. The most common serotype detected in the tested samples was DEN-3 in 55% cases (22/40, 13 monoinfection and 9 coinfection with DEN-1 and DEN-2). The present study gives an insight into the trend of dengue seropositivity among suspected cases in the western part of Rajasthan, India. This study showed a higher seroprevalence of dengue infection as well as a gradual increase in the seroprevalence in this part of India.
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Affiliation(s)
- Jitu M Kalita
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Alisha Aggarwal
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kavita Yedale
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravisekhar Gadepalli
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vijaya L Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Kombade SP, Abhishek KS, Mittal P, Sharma C, Singh P, Nag VL. Antifungal profile of vulvovaginal candidiasis in sexually active females from a tertiary care hospital of Western Rajasthan. J Family Med Prim Care 2021; 10:398-402. [PMID: 34017760 PMCID: PMC8132794 DOI: 10.4103/jfmpc.jfmpc_1124_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/09/2020] [Accepted: 10/08/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction: Vulvovaginal candidiasis (VVC) is the commonest form of sexually transmitted infection especially in sexually active females. Various species of Candida i.e., Candida albicans and non-albicans Candida are associated with VVC. More than 75% of women experiences vulvovaginal candidiasis at least once in their lifetime and 10% of it can lead to recurrent VVC. So, this study was planned to evaluate the clinico-mycological profile and antifungal profile of VVC in sexually active female attending tertiary care hospital. Materials and Methods: The present two months study was conducted in sexually active females attending Obstetrics –gynecology OPD with VVC in tertiary care hospital. Two high vaginal swabs were taken and fungal culture was done on SDA agar by standard methods. Identification and antifungal susceptibility testing of candidial isolates were done by standard mycological methods. Results: Most of the patients belonged to younger age group between 18 and 29 years (55%). Lower abdominal pain was the most common symptom after vaginal discharge followed by burning sensation and pruritis. Candida glabrata (15) with 58% of all the isolates was the most common Candida species associated with VVC in this study, followed by Candida albicans (5, 19%). Highest antifungal resistance was observed to itraconazole (81%) followed by amphotericin B (35%) and fluconazole (31%). 81% resistance to itraconazole among Candida glabrata and Candida albicans. Voriconazole was maximum susceptible to all Candida species. Conclusion: This study highlights the incidence of VVC among sexually active females of reproductive age group as its recurrence may result into obstetric complications and even infertility and also enlightens the common Candida species and their antifungal profile, which would help the treating clinicians to formulate local antifungal treatment policy for VVC.
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Affiliation(s)
- Sarika P Kombade
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Kumar S Abhishek
- Department of Microbiology, Institute of Medical Sciences (IMS), BHU, Varanasi, Uttar Pradesh, India
| | - Payal Mittal
- MBBS Student, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Charu Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Pratibha Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Vijaya L Nag
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Kalita JM, Yedale K, Tak V, Nag VL, Kumar D, Bohra GK. Immune thrombocytopenia, Strongyloides stercoralis hyperinfection syndrome with coinfection of Cryptosporidium: A rare case. INDIAN J PATHOL MICR 2021; 64:221-223. [PMID: 33433454 DOI: 10.4103/ijpm.ijpm_787_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jitu M Kalita
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kavita Yedale
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vijaya L Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Kumar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gopal K Bohra
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Goel AD, Bhardwaj P, Gupta M, Kumar N, Jain V, Misra S, Saurabh S, Garg MK, Nag VL. Swift contact tracing can prevent transmission-Case report of an early COVID-19 positive case. J Infect Public Health 2020; 14:260-262. [PMID: 33493923 PMCID: PMC7831398 DOI: 10.1016/j.jiph.2020.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 11/17/2022] Open
Abstract
This is a case study of a positive COVID-19 case who was diagnosed and isolated early on in the infection. However, her seventeen close contacts who were quarantined and under observation remained negative indicating no viable chain of transmission despite high-risk contact. We further discuss the importance of effective contact tracing coupled with strict isolation or quarantine in breaking the chain of transmission.
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Affiliation(s)
| | | | - Manoj Gupta
- All India Institute of Medical Sciences, Jodhpur, India
| | - Nitesh Kumar
- All India Institute of Medical Sciences, Jodhpur, India
| | - Vidhi Jain
- All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- All India Institute of Medical Sciences, Jodhpur, India
| | - Suman Saurabh
- All India Institute of Medical Sciences, Jodhpur, India
| | | | - Vijaya L Nag
- All India Institute of Medical Sciences, Jodhpur, India
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Samantaray S, Nag VL, Rawat P, Misra S, Aggarwal A, Khan S, Gadepalli RS, Kombade SP, Deepak, Dutt N, Garg MK, Bharadwaj P, Manda B. Demographic Profile of COVID-19 Cases: An Early Analysis of the Local Outbreak in a "Hotspot District" of Western Rajasthan in India. Asia Pac J Public Health 2020; 33:138-140. [PMID: 33289399 DOI: 10.1177/1010539520975288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Vijaya L Nag
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pankaj Rawat
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Alisha Aggarwal
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Salman Khan
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Sarika P Kombade
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naveen Dutt
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra K Garg
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pankaj Bharadwaj
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Balwant Manda
- Chief Medical Health Officer (CMHO), Jodhpur, Rajasthan, India
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Saurabh S, Kumar R, Gupta MK, Bhardwaj P, Nag VL, Garg MK, Misra S. Prolonged persistence of SARS-CoV-2 in the upper respiratory tract of asymptomatic infected individuals. QJM 2020; 113:556-560. [PMID: 32609360 PMCID: PMC7337859 DOI: 10.1093/qjmed/hcaa212] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/18/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Duration of persistence of SARS-CoV-2 in the upper respiratory tract of infected individuals has important clinical and epidemiological implications. AIM We aimed to establish the duration and risk factors for persistence of SARS-CoV-2 in the upper respiratory tract of asymptomatic infected individuals. METHODS Data of repeat rRT-PCR (real-time reverse transcription-polymerase chain reaction) test done for SARS-CoV-2 infected individuals at our institute at Jodhpur, India were analysed from 19 March to 21 May 2020. Duration of virus persistence was estimated with parametric regression models based on weibull, log-normal, log-logistic, gamma and generalized gamma distributions. Factors associated with prolonged viral persistence were analysed with the best-fitting model. RESULTS Fifty-one SARS-CoV-2 infected individuals with repeat rRT-PCR test were identified with 44 asymptomatics. The asymptomatic individuals had median virus persistence duration of 8.87 days (95% CI: 7.65-10.27) and 95 percentile duration of 20.70 days (95% CI: 16.08-28.20). The overall median virus persistence including both symptomatic and asymptomatic individuals was found to be 9.18 days (95% CI: 8.04-10.48). Around one-fourth asymptomatics (10/44) demonstrated SARS-CoV-2 persistence beyond 2 weeks. Age <60 years and local transmission were found to be significantly associated with longer virus persistence among asymptomatic individuals on univariate regression but not in multivariate analysis. CONCLUSION Recommended home isolation duration for SARS-CoV-2 infected individuals in India should be extended from 17 days to at least 3 weeks. Prolonged persistence of SARS-CoV-2 in a considerable proportion of asymptomatic individuals merits attention with regard to ensuring universal infection prevention precautions irrespective of symptomatic status.
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Affiliation(s)
- S Saurabh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, India
| | - R Kumar
- Engineering Science Laboratory - Central Scientific Instruments Organization (CSIO), Council for Scientific and Industrial Research (CSIR), Chandigarh 160030, India
| | - M K Gupta
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, India
| | - P Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, India
| | | | | | - S Misra
- Director, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, India
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Sureka B, Rai B, Varshney V, Nag VL, Garg MK, Garg PK, Yadav T, Khera PS, Goel A. Quantitative diffusion-weighted magnetic resonance imaging for prediction of early infection in pancreatic collections: Results of a pilot study. Saudi J Gastroenterol 2019; 26:20-25. [PMID: 31997778 PMCID: PMC7045770 DOI: 10.4103/sjg.sjg_411_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND/AIMS The development of infection in pancreatitis increases the mortality rate up to 32%. Therefore, it is important to identify patients who are at high risk of developing infection, at an early stage. The objectives of the study were (a) to analyze the quantitative parameters of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) in infected as well as sterile pancreatic collections (b) to establish "cut-off" values for ADC that can identify infected pancreatic collections. MATERIALS AND METHODS Prospective observational study of pancreatitis cases who underwent DW-MRI from August 2018 to July 2019 were enrolled in the study. The collections were analyzed for diffusion restriction. The average of the three ADC values from the wall and center of collection was noted. RESULTS Infected collections were seen in 7 and sterile collections observed in 11 cases. The optimal cut-off ADC value to differentiate sterile and infected collection in our study was 1.651 × 10-3 mm2/s (sensitivity of 81.8%; specificity of 100.0%). ROC curve for mean ADC from the wall showed a significant diagnostic accuracy with AUC: 0.91; 95% CI: 0.77-1.0 (P = 0.004). CONCLUSION DW-MRI is a reliable noninvasive technique to differentiate sterile and infected pancreatic collections. ADC values from the periphery of the collection can predict infected pancreatic collections at an early stage. DW-MRI should not be considered as a substitute for aspiration cytology in patients with septic symptoms and absent diffusion restriction on MRI.
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Affiliation(s)
- Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India,Address for correspondence: Dr. Binit Sureka, Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan, India. E-mail:
| | - Balwant Rai
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Vaibhav Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Vijaya L. Nag
- Department of Microbiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Mahendra K. Garg
- Department of General Medicine, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Pawan K. Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Pushpinder S. Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Akhil Goel
- Department of Community Medicine, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
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Sharma A, Kalita JM, Nag VL. Screening for Methicillin-resistant Staphylococcus aureus Carriage on the Hands of Healthcare Workers: An Assessment for Hand Hygiene Practices. Indian J Crit Care Med 2019; 23:590-592. [PMID: 31988552 PMCID: PMC6970211 DOI: 10.5005/jp-journals-10071-23296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is capable of causing a wide range of infections. Colonized healthcare workers (HCWs) and contaminated hand-touch surfaces act as a potential source of MRSA in hospitals. This study was conducted to detect the carriage of MRSA in the hands of HCWs during patient care to check awareness among HCWs to follow proper hand hygiene protocol. Materials and methods This study was a cross-sectional point prevalence study done in wards and intensive care units (ICUs) of a tertiary care hospital. Hand cultures were collected from HCWs after the clinical rounds, without prior information about the procedure. It was done on three consecutive days to include maximum HCWs from the hospital. Cultures were taken before and after the use of alcohol-based hand rub. Hand cultures were obtained by asking HCWs to touch the surface of chromogenic screening agar for MRSA with their fingertips and thumbs of both the hands. Results Of a total of 62 HCWs screened, 32 (51.61%) were positive for MRSA. Among these, seven were doctors. After using alcohol-based hand rub, six HCWs were still positive for MRSA. Another important finding on this screening agar was detection of Candida on the hands of HCWs. Conclusion Regular monitoring of hand hygiene compliance is vital to prevent the spread of nosocomial infections. The MRSA screening agar is rapid, simple, cost-effective, and useful to identify the carriage of not only MRSA but also Candida (in the wake of nosocomial outbreaks with Candida auris) in the hands of HCWs. Further studies are required to evaluate the transmission rate of MRSA from HCWs to patients in Indian hospitals. How to cite this article Sharma A, Kalita JM, Nag VL. Screening for Methicillin-resistant Staphylococcus aureus Carriage on the Hands of Healthcare Workers: An Assessment for Hand Hygiene Practices. Indian J Crit Care Med 2019;23(12):590–592.
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Affiliation(s)
- Anuradha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jitu M Kalita
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vijaya L Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Maurya AK, Nag VL, Kant S, Kushwaha RS, Dhole TN. Genotypic analysis of multidrug-resistant tuberculosis isolates from extra pulmonary tuberculosis cases in tertiary care centers in Northern India. Int J Mycobacteriol 2016; 5 Suppl 1:S125-S126. [DOI: 10.1016/j.ijmyco.2016.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022] Open
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Maurya AK, Singh AK, Kant S, Umrao J, Kumar M, Kushwaha RAS, Nag VL, Dhole TN. Use of GenoType® MTBDRplus assay to assess drug resistance and mutation patterns of multidrug-resistant tuberculosis isolates in northern India. Indian J Med Microbiol 2014; 31:230-6. [PMID: 23883707 DOI: 10.4103/0255-0857.115625] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE The emergence and spread of multidrug-resistant tuberculosis (MDR-TB) is a major public health problem. The diagnosis of MDR-TB is of paramount importance in establishing appropriate clinical management and infection control measures. The aim of this study was to evaluate drug resistance and mutational patterns in clinical isolates MDR-TB by GenoType® MTBDRplus assay. MATERIAL AND METHODS A total of 350 non-repeated sputum specimens were collected from highly suspected drug-resistant pulmonary tuberculosis (PTB) cases; which were processed by microscopy, culture, differentiation and first line drug susceptibility testing (DST) using BacT/ALERT 3D system. RESULTS Among a total of 125 mycobacterium tuberculosis complex (MTBC) strains, readable results were obtained from 120 (96%) strains by GenoType® MTBDRplus assay. Only 45 MDR-TB isolates were analysed for the performance, frequency and mutational patterns by GenoType® MTBDRplus assay. The sensitivity of the GenoType® MDRTBplus assay for detecting individual resistance to rifampicin (RIF), isoniazid (INH) and multidrug resistance was found to be 95.8%, 96.3% and 97.7%, respectively. Mutation in codon S531L of the rpoB gene and codon S315T1 of katG genes were dominated in MDR-TB strains, respectively (P < 0.05). CONCLUSIONS The GenoType® MTBDRplus assay is highly sensitive with short turnaround times and a rapid test for the detection of the most common mutations conferring resistance in MDR-TB strains that can readily be included in a routine laboratory workflow.
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Affiliation(s)
- A K Maurya
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Maurya AK, Singh AK, Kumar M, Umrao J, Kant S, Nag VL, Kushwaha RAS, Dhole TN. Changing patterns and trends of multidrug-resistant tuberculosis at referral centre in Northern India: A 4-year experience. Indian J Med Microbiol 2013; 31:40-6. [DOI: 10.4103/0255-0857.108720] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dhole TN, Singh AK, Maurya AK, Umrao J, Nag VL, Kant S, Kushwaha RAS. Rapid detection of drug resistance and mutational patterns of extensively drug-resistant strains by a novel GenoType®MTBDRsl assay. J Postgrad Med 2013; 59:179-85. [DOI: 10.4103/0022-3859.118034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Maurya AK, Kant S, Nag VL, Kushwaha R, Dhole TN. Detection of 123 bp fragment of insertion element IS6110 Mycobacterium tuberculosis for diagnosis of extrapulmonary tuberculosis. Indian J Med Microbiol 2012; 30:182-6. [PMID: 22664434 DOI: 10.4103/0255-0857.96688] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE Extrapulmonary tuberculosis (EPTB) is emerging problem in developing and developed countries. The diagnosis of EPTB in its different clinical presentations remains a true challenge. IS6110-based polymerase chain reaction (PCR) is used for rapid identification and positivity rate of the Mycobacterium tuberculosis complex in clinical isolates of different sites of EPTB. The present study was carried out to study the prevalence of M. tuberculosis complex in clinical isolates of EPTB at tertiary care centres in Lucknow. MATERIALS AND METHODS Seven hundred fifty-six specimens were collected from the suspected cases of EPTB which were processed for Mycobacteria by Ziehl Neelson (ZN) staining and BACTEC culture. All the specimens were also processed for IS6110-based PCR amplification with primers targeting 123 bp fragment of insertion element IS6110 of the M. tuberculosis complex. RESULTS Of these 756 specimens, 71(9.3%) were positive for acid fast bacilli (AFB) by ZN staining, 227(30.1%) were positive for mycobacteria by BACTEC culture and IS6110 PCR were positive for M. tuberculosis complex in 165 (20.7%) isolates. We found a significant difference in sensitivities of different tests (P<0.05). CONCLUSIONS This study reveals the positivity of M. tuberculosis complex in clinical isolates of EPTB case in tertiary care hospitals in Northern India. 72.7% of M. tuberculosis complex was confirmed by IS6110-PCR in culture isolates from different sites of EPTB. The high prevalence of the M. tuberculosis complex was seen in lymph node aspirate and synovial fluid. However, utility of PCR may play a potentially significant role in strengthening the diagnosis of EPTB especially targeting IS6110.
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Affiliation(s)
- A K Maurya
- Department of Pulmonary Medicine, Chhatrapati Shahuji Maharaj Medical University, Lucknow 226 003, (Erstwhile King George Medical College), India
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Kant S, Nag VL, Kushwaha RAS, Dhole TN, Maurya AK. Trends of anti-tuberculosis drug resistance pattern in new cases and previously treated cases of extrapulmonary tuberculosis cases in referral hospitals in northern India. J Postgrad Med 2012; 58:185-9. [DOI: 10.4103/0022-3859.101379] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kant S, Maurya AK, Kushwaha RAS, Nag VL, Prasad R. Multi-drug resistant tuberculosis: an iatrogenic problem. Biosci Trends 2010; 4:48-55. [PMID: 20448341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The occurrence of resistance to drugs used to treat tuberculosis (TB), and particularly multi-drug resistant TB (MDR-TB) defined as resistance to at least rifampicin and isoniazid, has become a significant public health dilemma in a number of countries and an obstacle to effective global TB control. HIV-associated MDR-TB understanding is vital in providing strategies for treatment of HIV and drug-resistant TB. Better understanding on the basis of drug action and resistance is a key to development of diagnostic strategies, novel drugs, and treatment programs, and to find an approach to study the pathogenicity of drug resistant strains. The effectiveness of strategies such as DOTS-Plus in the management of MDR-TB patients under program conditions should be tested in operational field clinical trials following strictly standardized definitions and nomenclature.
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Affiliation(s)
- Surya Kant
- Department of Pulmonary Medicine, C. S. M. Medical University UP, Lucknow, India.
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Nag VL, Khare V, Awasthi S, Agrawal SK. Clinical profile and prevalence of rotavirus infection in children presented with acute diarrhea at tertiary care referral hospital at northern part of India. J Commun Dis 2009; 41:183-188. [PMID: 22010485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A prospective analysis of 90 clinically diagnosed cases with acute diarrhea over a period of one year was carried out to determine the prevalence of rotavirus infection in children between 2 months to 2 years of age. Enzyme Linked Immunosorbent Assay (ELISA) and Polyacrylamide Gel Electrophoresis (PAGE) were used for detection of rotavirus from stool sample. Fourteen (15.6%) of them were found to be positive for group A rotavirus, 9 (23%) cases were between 6 months to 1 year of age. Rotavirus excretion was highest (50%) when all three symptoms (diarrhea, vomiting and fever) occurred in the same child. A planned study for surveillance of rotavirus serotypes is required from this area.
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Affiliation(s)
- V L Nag
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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Venkatesh V, Patibandla PK, Agarwal GG, Awasthi S, Ahuja RC, Nag VL, Kushwaha KP, Agarwal SK. Performance characteristics of a rapid diagnostic test for malaria, when used to confirm cerebral malaria in children and young adults. Ann Trop Med Parasitol 2007; 101:85-7. [PMID: 17244413 DOI: 10.1179/136485907x154647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- V Venkatesh
- Department of Microbiology, King George's Medical University, Lucknow - 226003, Uttar Pradesh, India.
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Nag VL, Ayyagari A, Venkatesh V, Dash NR, Ghar M, Prasad KN. Bacterial isolates from mechanically ventilated patients with nosocomial pneumonia within intensive care unit of a tertiary care center. J Commun Dis 2005; 37:281-7. [PMID: 17278658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Nosocomial pneumonia is a common complication in mechanically ventilated patients. A study was carried out to determine the incidence, common bacterial etiologic agents and their antimicrobial susceptibility, and outcome of such pneumonia in an Intensive Care Unit (ICU) of a tertiary care center. In Surgical ICU (SICU) 176 patients required mechanical ventilation for more than 72 hours. A total of 39 (22.1%) of these patients developed nosocomial bacterial pneumonia as determined by microbiological assays. Endotracheal aspirate cultures detected a single bacterial isolate in 22 (56.4%) patients while two and three organisms were isolated from 10 (25.6%) and 7 (17.9%) patients respectively. Fifty three (84.1%) of a total of 63 isolates were Gram negative bacilli. The most frequently encountered pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter species among the Gram negative bacilli and Staphylococcus aureus among the Gram positives. Resistance of bacterial isolates varied from 24 to 90% against commonly used antibiotics. Amikacin had the best profile, with 14% to 55% resistance against various isolates. Twenty three (59%) of 39 patients with pneumonia expired in the ICU. P. aeruginosa (25.6%) and K. pneunmoniae (17.9%) were the predominant isolates in these patients. Nosocomial pneumonia with high mortality is a frequent occurrence in mechanically ventilated patients in our ICU setting. Gram negative organisms with high levels of antimicrobial resistance are the most common isolates. Regular surveillance and monitoring of changes in antibiotic susceptibility of bacterial pathogens and appropriate therapeutic measures are likely to reduce the mortality in these patients.
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Affiliation(s)
- V L Nag
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014
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Prasad R, Saini JK, Gupta R, Kannaujia RK, Sarin S, Kulshreshth R, Nag VL, Tripathi AK. A comparative study of clinico-radiological spectrum of tuberculosis among HIV seropositive and HIV seronegative patients. Indian J Chest Dis Allied Sci 2004; 46:99-103. [PMID: 15072324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND A study to determine the prevalence of human immunodeficiency virus (HIV) infection among tuberculosis patients and to compare the clinico-radiological spectrum of tuberculosis among HIV seropositive and seronegative patients was carried out in the Department of TB and Chest Diseases, CSM Medical University, Lucknow (Uttar Pradesh), India. METHODS A total of 1105 radiologically and/or bacteriologically confirmed patients of tuberculosis were screened for HIV infection during the years 1995 to 1997 and from 2000-2001. RESULTS Out of a total 1105 patients screened, 31(2.8%) were found to be HIV seropositive. Tuberculin positivity was less among HIV seropositive patients as compared to HIV seronegative patients (22.6% vs 76.4%; p < 0.001). There was no statistically significant difference in sputum smear positivity for acid-fast bacilli (AFB) among HIV seropositive and seronegative patients. Among HIV seropositive patients, mid and lower zone involvement, exudative lesions and mediastinal lymphadenopathy was more common as compared to the seronegative patients. CONCLUSION HIV seropositivity rates among tuberculosis patients was 2.8 percent. The presentation of tuberculosis was more often atypical among these patients.
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Affiliation(s)
- R Prasad
- Department of TB Diseases, K.G. Medical University, CSM Medical University, Lucknow, India.
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Prasad KN, Agarwal J, Nag VL, Verma AK, Dixit AK, Ayyagari A. Cryptococcal infection in patients with clinically diagnosed meningitis in a tertiary care center. Neurol India 2003; 51:364-6. [PMID: 14652440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-and-a-half years was carried out to determine the prevalence of cryptococcal infection, its associated risk factors and therapeutic outcome. Fifty-four (16.6%) patients with cryptococcal meningitis were identified by smear examination, culture and/or cryptococcal antigen latex agglutination test. Records of 45 cryptococcal meningitis patients were available; 18 (40%) of them were apparently healthy immunocompetent individuals, 13 (28.9%) had human immunodeficiency virus (HIV) infection, 9 (20%) were renal transplant recipients, 4 (8.9%) were diabetic and 1 (2.2%) had systemic lupus erythematosus. Ten (22.2%) patients died and 11 (24.4%) patients (all HIV-positive) left against medical advice. The present study indicates that cryptococcal infection is associated with high mortality. Presenting symptoms being indistinguishable from other causes of central nervous system infection, all patients with a clinical diagnosis of meningitis, irrespective of their immune status should be investigated for cryptococcal infection.
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Affiliation(s)
- K N Prasad
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226014, India.
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Nag VL, Agarwal P, Venkatesh V, Rastogi P, Tandon R, Agrawal SK. A pilot study on observations on CD4 & CD8 counts in healthy HIV seronegative individuals. Indian J Med Res 2002; 116:45-9. [PMID: 12592989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND & OBJECTIVES CD4 T lymphocyte count is used to measure the progression of HIV infection and is recommended as part of the standard care of HIV infected person. Information on reference CD4 counts and CD4:CD8 ratio in healthy individuals is lacking in India. Therefore the present study was undertaken to obtain base-line data on CD4 counts and CD4:CD8 ratio of healthy population from north India and to assess the feasibility of using the values as reference in an extended larger study. METHODS In this pilot study 84 HIV negative healthy volunteers (56 males, 28 females) in the age group of 20-59 yr and who were willing to participate in the study were enrolled after proper counseling. Blood specimens were collected from each subject and processed for anti-HIV antibodies for exclusion of HIV. CD4 and CD8 counts of the samples were performed by fluorescence activated cell sorting (FACS). RESULTS The mean +/- SD of the absolute numbers of CD4 and CD8 lymphocytes/microliter was 763.6 +/- 226 and 547.5 +/- 190 in males and 797.9 +/- 263 and 567.7 +/- 250 in females. The range of the CD4 and CD8 counts was 365-1328 and 264-991 in males and 415-1257 and 224-1126 in females respectively. The mean +/- SD of the CD4:CD8 ratio was 1.47 +/- 0.42 in males and 1.52 +/- 0.45 in females. INTERPRETATION & CONCLUSION The results of this study showed that there is wide variability in CD4 count in our population, as is seen in studies reported from other parts of India. A large multicentric study could define the normal range for CD4 and CD8 counts and CD4:CD8 ratio in the Indian population.
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Affiliation(s)
- V L Nag
- Department of Microbiology, King George's Medical College, Lucknow, India
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Prasad KN, Pradhan S, Nag VL. Guillain-Barre syndrome and Campylobacter infection. Southeast Asian J Trop Med Public Health 2001; 32:527-30. [PMID: 11944711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Campylobacter infection of the gastrointestinal tract has been observed as an antecedent illness in some patients with Guillain-Barre syndrome (GBS); these patients have been reported to have poor prognosis. We investigated 29 patients with GBS, admitted to our hospital from January 1996 to December 1999 for recent Campylobacter enteritis by culture of their stool specimens. Campylobacter upsaliensis and C. jejuni were isolated from stools of one patient each with acute motor axonal neuropathy (AMAN) and acute inflammatory demyelinating polyradiculoneuropathy (AIDP) respectively. The patient with C. upsaliensis infection was a 7 year-old male child who developed features of AMAN, 7 days after onset of diarrhea. He recovered gradually within 24 days with residual deficit in the form of foot drop. This deficit has persisted for last three and half years. The other patient with C. jejuni infection was a 9 year-old boy, who developed AIDP after 9 days of acute diarrhea. This patient recovered completely within 28 days of illness without any deficit. None of the patients had relapse of GBS. The present findings indicate the need of planned systematic studies to explore the role of C. upsaliensis and other campylobacters as agents of antecedent diarrhea in patients of GBS with different clinical presentations and prognosis.
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Affiliation(s)
- K N Prasad
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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Nag VL, Ayyagari A, Venkatesh V, Ghar M, Yadav V, Prasad KN. Drug resistant Haemophilus influenzae from respiratory tract infection in a tertiary care hospital in north India. Indian J Chest Dis Allied Sci 2001; 43:13-7. [PMID: 11370501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Haemophilus influenzae is an important respiratory pathogen. Emergence of resistance to various antibiotics is a major problem in patient management. A total of 90 strains of H. influenzae were characterized from specimens obtained from patients of acute respiratory tract infection; 13 (14.4%) belonged to type beta. On biotyping, 90% strains belonged to biotype II. The frequency of resistance to various antibiotics was as follows: cotrimoxazole 33.3% ampicillin 21.1%, cephalexin 7.8%, chloramphenicol 7.8%, ciprofloxacin 2.5% erythromycin and tetracycline 5% each. All the ampicillin-resistant strains produced beta-lactamase as detected by nitrocefin disc method. None of the strains exhibited resistance to cefaclor and third generation cephalosporins. The present study showed emergence of variable resistance to ampicillin, cotrimoxazole and other antibiotics. It is important for the clinical microbiology laboratory to monitor drug resistant strains for instituting appropriate antibiotic therapy of respiratory infections due to H. influenzae.
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Affiliation(s)
- V L Nag
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareilly Road, Lucknow-226 014
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Prasad KN, Nag VL, Dhole TN, Ayyagari A. Identification of enteric pathogens in HIV-positive patients with diarrhoea in northern India. J Health Popul Nutr 2000; 18:23-26. [PMID: 11014766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Enteric pathogens associated with chronic diarrhoea in HIV-positive patients were studied. The study was conducted during January 1995-December 1998. Stool specimens from all diarrhoea patients (n = 26) were examined microscopically for ova and parasites using wet preparations and stained smears. Stool samples from diarrhoea patients were also cultured on appropriate media to isolate enteric bacterial pathogens. Of the 59 patients, 26 (44%) had prolonged diarrhoea for more than 4 weeks. Enteric pathogens were detected in 19 (73%) of the 26 patients: 17 patients harboured a single pathogen, and 2 patients had mixed pathogens. The detection rate of emerging parasites, including Isospora, Cryptosporidium, Blastocystis hominis, and Strongyloides stercoralis as a single agent, was significantly higher than conventional pathogens (50% vs 19.2%; p < 0.05). Only one patient harboured both conventional and emerging pathogens (Entamoeba histolytica and Cryptosporidium). Isospora belli was detected in 8 (31%) of the 26 diarrhoea patients: in 7 (27%) patients as a single agent and in one patient with S. stercoralis. Cryptosporidium was identified in 3 (11%) diarrhoea patients: in 2 (8%) patients as a single agent and in one patient with E. histolytica, followed by B. hominis in 2 (8%) patients. E. histolytica was most commonly isolated (3/26; 11.5%), followed by Giardia lamblia, enteropathogenic Escherichia coli, and Campylobacter jejuni (one patient each). Parasitic pathogens were frequently associated with HIV-positive patients with diarrhoea in northern India. I. belli was the most frequent parasite isolated, followed by Cryptosporidium. Stools of all HIV-positive patients with diarrhoea should thoroughly be investigated to identify aetiologic agents for proper management.
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Affiliation(s)
- K N Prasad
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Abstract
Nocardia asteroides is an important opportunistic pathogen in immunocompromised hosts. The primary infection is usually in the lungs and is followed by dissemination to other parts of the body. Primary subcutaneous infection with Nocardia asteroides has been reported rarely (three reports) and no such case has been reported in a renal transplant recipient. We describe here a case of renal transplant recipient who developed primary subcutaneous infection with Nocardia asteroides within one and half years of the transplantation.
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Affiliation(s)
- R Agarwal
- Departments of Mircobiology and Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-266 014, India
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Paul VK, Singh M, Gupta U, Buckshee K, Bhargava VL, Takkar D, Nag VL, Bhan MK, Deorari AK. Chlamydia trachomatis infection among pregnant women: prevalence and prenatal importance. Natl Med J India 1999; 12:11-4. [PMID: 10326323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Chlamydia trachomatis infection in pregnant women is suspected to result in low birth-weight and premature infants. We conducted studies to ascertain the prevalence of this infection among pregnant women in our setting and whether its presence is a risk factor for low birth-weight or prematurity. METHODS In the first study, 94 pregnant women between 26 and 30 weeks of gestation were screened for infection with Chlamydia trachomatis. The second investigated a cohort of 172 pregnant women presenting in spontaneous labour. The infection status was related to perinatal outcome in terms of birth-weight and gestation. In both the studies, Chlamydia trachomatis infection was diagnosed using the Chlamydiazyme test performed on endocervical swabs. RESULTS The prevalence of Chlamydia trachomatis infection in mid-pregnancy and at labour was 17% (16/94) and 18.6% (32/172), respectively. Women with infection were relatively older than those without it [mean (SD) age: 26.6 (4.5) years v. 24.8 (3.6) years, p = 0.01]. The mean (SD) birth-weight [2869 (611) g v. 2814 (496) g], gestation [38.5 (2.6) weeks v. 38.3 (2.0) weeks], and incidence of low birth-weight [18.7% v. 20.7%] as well as prematurity [9.4% v. 10.7%] were similar among neonates born to women with or without infection. Neonates born to infected mothers experienced purulent conjunctivitis more frequently than those born to non-infected mothers [12.5% v. 2.8%, p = 0.04]. CONCLUSION Chlamydia trachomatis is a relatively common infection in pregnant women. However, it was not associated with either low birth-weight or prematurity.
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Affiliation(s)
- V K Paul
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Abstract
OBJECTIVE This study was conducted to document the prevalence of maternal genital tract colonization by Ureaplasma urealyticum and Mycoplasma hominis, and to assess its association with low birth weight (LBW) and prematurity. METHODS The high vaginal swabs of pregnant women in spontaneous labor after 26 weeks of gestation were cultured for U. urealyticum and M. hominis. Clinical details and perinatal outcomes including birth weight and gestation were documented. RESULTS Of a total of 303 women enrolled, 148 (48.8%) had positive vaginal cultures for U. urealyticum, while only five (1.6%) grew M. hominis. The mean birth weight and the incidences of LBW and preterm neonates among ureaplasma positive and ureaplasma negative mothers were statistically comparable. CONCLUSIONS U. urealyticum emerged as a common inhabitant of the lower genital tract of women in labor, being present in nearly half of them. Its presence was not a risk factor of LBW or prematurity. Maternal colonization with M. hominis was uncommon.
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Affiliation(s)
- V K Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
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Jain A, Nag VL, Goel MM, Chandrawati, Chaturvedi UC. Adverse foetal outcome in specific IgM positive Chlamydia trachomatis infection in pregnancy. Indian J Med Res 1991; 94:420-3. [PMID: 1774093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A study was undertaken to determine the adverse foetal outcome in antichlamydial IgM positive asymptomatic pregnant females. An indirect immunoperoxidase assay was done to detect IgM in 78 apparently normal asymptomatic pregnant women during the third trimester and follow up was done till delivery to study the effect of chlamydial infection on foetal outcome. A total of 28 (35.9%) women were positive for antichlamydial IgM while only 3.33 per cent asymptomatic non-pregnant normal women (controls) were positive. 28.7 per cent IgM positive mothers delivered low birth weight (LBW) babies (P less than 0.05), 9.7 per cent had premature labour (PTL) and 4.7 per cent had intrauterine death (IUD). The findings are significant as none of the IgM negative mothers had PTL and IUD and only 2.6 per cent had LBW babies.
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Affiliation(s)
- A Jain
- Postgraduate Department of Microbiology, K.G. Medical College, Lucknow
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