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Kaur M, Singla N, Aggarwal D, Kundu R, Gulati N, Kumar MB, Gombar S, Chander J. Antifungal Susceptibility Profile of Clinical and Environmental Isolates of Aspergillus Species From a Tertiary Care Center in North India. Cureus 2024; 16:e54586. [PMID: 38524068 PMCID: PMC10958134 DOI: 10.7759/cureus.54586] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
INTRODUCTION Aspergillus species are ubiquitously found in the environment worldwide and are important causative agents for infection. Drug resistance among Aspergillus species is emerging, hence the present study was undertaken to look for antifungal susceptibility profiles of clinical and environmental isolates of Aspergillus species. MATERIALS AND METHODS During the period from January 2018 to June 2019, a total of 102 Aspergillus isolates (40 clinical, 40 hospital, and 22 community environment) were tested for antifungal susceptibility testing for determination of minimum inhibitory concentration (MIC)/minimum effective concentration (MEC) as per Clinical and Laboratory Standards Institute (CLSI) M38-A3 method for itraconazole, voriconazole, amphotericin B, and caspofungin. RESULTS Out of these 102 Aspergillus isolates, A. flavus was the most common species present. Aspergillus species were found to have low MIC values to azoles such as itraconazole and voriconazole except for one clinical isolate, which showed a MIC value of 2 μg/ml to voriconazole. Two isolates were non-wild-type for amphotericin B, but all isolates were wild-type for caspofungin. CONCLUSION Antifungal susceptibility testing among clinical Aspergillus isolates and environmental surveillance studies in view of emerging drug resistance should be undertaken at a larger scale.
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Affiliation(s)
- Manharpreet Kaur
- Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Nidhi Singla
- Microbiology, Government Medical College, Chandigarh, Chandigarh, IND
| | - Deepak Aggarwal
- Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Reetu Kundu
- Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Neelam Gulati
- Clinical Microbiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Mani Bhushan Kumar
- Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Satinder Gombar
- Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Jagdish Chander
- Microbiology, Government Medical College, Chandigarh, Chandigarh, IND
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Sangma VSC, Jaggi S, Saini V, Aggarwal D, Kumar P, Chander J. Prevalence of latent tuberculosis infection in household contacts of pulmonary tuberculosis, time to treat. Monaldi Arch Chest Dis 2023; 94. [PMID: 37218425 DOI: 10.4081/monaldi.2023.2563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
Treatment of latent pulmonary tuberculosis (TB) in household contacts has been included in the National Tuberculosis Elimination Program to achieve the target of TB elimination by the Government of India by 2025. However, there are no clear estimates of the prevalence of latent TB among the contacts that could suggest the impact of this intervention. The study was conducted to determine the prevalence of and factors predicting latent TB among household contacts with pulmonary TB. All microbiologically confirmed pulmonary TB patients registered between January 2020 and July 2021 and their household contacts were enrolled. All contacts underwent Mantoux testing to determine the prevalence of latent TB. All symptomatic patients also underwent chest radiographs and sputum examinations to diagnose active pulmonary TB. Thereafter, different demographic and clinical factors were evaluated to find predictors of latent TB using a logistic regression model. A total of 118 pulmonary TB cases and their 330 household contacts were enrolled. The prevalence of latent TB and active TB among the contacts was found to be 26.36% and 3.03%, respectively. The female gender of index TB cases was independently associated with a high proportion of latent TB cases in the family (adjusted odds ratio 2.32; 95% confidence interval 1.07-5.05; p=0.03). Neither the higher sputum smear positivity nor the severity of the chest radiograph of index TB cases had any association with the number of contacts being diagnosed as latent TB or active TB. The results showed a significant prevalence of latent TB among household contacts with pulmonary TB. The severity of the disease in the index patient had no association with the prevalence of latent TB.
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Affiliation(s)
- Vinnie Sarah Ch Sangma
- Department of Critical Care, Pushpawati Singhania Hospital and Research Institute, New Delhi.
| | - Surabhi Jaggi
- Department of Tuberculosis and Respiratory Diseases, Government Medical College and Hospital, Chandigarh.
| | - Varinder Saini
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh.
| | - Deepak Aggarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh.
| | - Pankaj Kumar
- epartment of Pediatrics, Government Medical College and Hospital, Chandigarh.
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh.
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Dhawan P, Singla N, Kundu R, Gulati N, Attri AK, Chander J. Phaeohyphomycosis: A study from tertiary health care center in North India. INDIAN J PATHOL MICR 2023; 66:314-320. [PMID: 37077074 DOI: 10.4103/ijpm.ijpm_204_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Objectives Phaeohyphomycosis refers to infections caused by phaeoid/dematiaceous or darkly pigmented fungi. This study was undertaken to further increase our knowledge about the incidence of phaeohyphomycosis and its causative agents. Materials and Methods The present study was conducted over a period of one and a half years (January 2018-June 2019) on specimens received from patients with varied clinical manifestations ranging from superficial infections, subcutaneous cysts, pneumonia, brain abscess to a disseminated infection. These specimens were processed in the Department of Microbiology for potassium hydroxide (KOH) examination and culture and in Pathology for cytology/histopathological examination (HPE). All specimens positive on direct examination for dark grey, brown or black fungi were included in the study. Results A total of 20 specimens were confirmed as phaeohyphomycosis. Most of the patients belonged to the age group of 41 to 50 years. Male: Female ratio was 2.3:1. Trauma was the most common risk factor. Spectra of the isolated fungal pathogens comprised of Bipolaris species, Exophiala species, Curvularia geniculata, Phialemonium species, Daldinia eschscholtzii, Hypoxylon anthochroum, Phaeoacremonium species, Leptosphaerulina australis, Medicopsis romeroi, Lasiodiplodia theobromae, Eutypella species, Chaetomium globosum, Alternaria species, Cladophialophora bantiana and 2 unidentified dematiaceous fungi. Recovery from phaeohyphomycosis was seen in 12 patients, 7 were lost to follow up and one patient succumbed to the illness. Conclusion Infections caused by phaeoid fungi can no longer be viewed as rare. In fact, phaeohyphomycosis can have myriad of presentations spanning from mild cutaneous infections to fatal brain disease. Therefore, a high index of clinical suspicion is needed to diagnose such infections. The primary treatment modality remains surgical removal of the lesion in cutaneous or subcutaneous infections however disseminated disease with a guarded prognosis requires aggressive management.
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Affiliation(s)
- Pallavi Dhawan
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Reetu Kundu
- Department of Pathology, Government Medical College Hospital, Chandigarh, India
| | - Neelam Gulati
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Ashok K Attri
- Department of General Surgery, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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Singh J, Gupta VK, Chander J, Gupta S. Fungal Infection: An Extremely Rare Differential for Cervical Myelopathy! Neurol India 2023; 71:350-352. [PMID: 37148072 DOI: 10.4103/0028-3886.375423] [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: 05/07/2023]
Affiliation(s)
- Jaskaran Singh
- Department of Neurosurgery, Government Medical College, Patiala, Punjab, India
| | - Vipin Kumar Gupta
- Department of Neurosurgery, Government Medical College and Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Soumya Gupta
- Department of Neurosurgery, Government Medical College and Hospital, Chandigarh, India
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Sharma A, Sharma R, Chander J, Nirankari V. In vitro antimicrobial efficacy of riboflavin, ultraviolet-A radiation, and combined riboflavin/ultraviolet-A radiation on ocular pathogens. Taiwan J Ophthalmol 2023; 13:21-27. [DOI: 10.4103/tjo.tjo_28_21] [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: 01/15/2021] [Accepted: 06/14/2021] [Indexed: 03/14/2023] Open
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Sharma S, Singla N, Gulati N, Arya SK, Chander J. Acrophialophora fusispora as an Agent of Mycotic Keratitis: A Case Report and Review of Literature. Infect Disord Drug Targets 2023; 23:1-5. [PMID: 36305156 DOI: 10.2174/1871526523666221026094300] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/27/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acrophialophora species is an infrequent human opportunistic pathogen. It is widely distributed in temperate as well as tropical regions. Here, we present a rare case of fungal keratitis caused by A. fusispora. CASE PRESENTATION A 26-year male driver presented with pain, watering, redness, whitish discoloration, and blurring of vision in the left eye for the last 3-4 days. Upon examination, he had a dry-looking corneal ulcer with infiltration and satellite lesions. Corneal scrapings were positive for septate fungal hyphae by Gram staining and KOH mount. After five days, the growth observed was presumptively identified as genus Acrophialophora and finally identified as Acrophialophora fusispora by genetic sequencing. The patient failed to respond medically and was planned for therapeutic keratoplasty. DISCUSSION To date, four cases of ocular involvement due to Acrophialophora have been described. Amongst which one case was associated with an immunocompromised state. Three of the cases were resolved medically, while one required therapeutic keratoplasty, indicating possible strong pathogenicity to the eye. CONCLUSION As Acrophialophora seems to have a predilection for eye infections, an early diagnosis with timely appropriate treatment is the best way to restore the normal vision of a patient.
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Affiliation(s)
- Swati Sharma
- Department of Microbiology and Ophthalmology, Government Medical College Hospital, Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology and Ophthalmology, Government Medical College Hospital, Chandigarh, India
| | - Neelam Gulati
- Department of Microbiology and Ophthalmology, Government Medical College Hospital, Chandigarh, India
| | - Sudesh Kumar Arya
- Department of Microbiology and Ophthalmology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology and Ophthalmology, Government Medical College Hospital, Chandigarh, India
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Moorthy A, Jaggi S, Garg K, Kaur Sodhi M, Aggarwal D, Chander J. Evaluation of patient's experiences with daily DOTS. Indian J Tuberc 2022; 69:453-459. [PMID: 36460375 DOI: 10.1016/j.ijtb.2021.07.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS Past few decades have seen major revisions in the Tuberculosis (TB) control programs time and again with a goal to strengthen the delivery of services and achieve elimination of the disease. Daily Directly Observed Treatment, Short-course (DOTS) Fixed dose combination (FDC) was one such major leap and aimed to simplify the treatment regimen, reduce pill burden, avoid drug monotherapy, improve compliance, reduce chances of drug resistance, decrease stigma and make the treatment more patient friendly. We intended to study the impact and acceptance of this changed FDC daily DOTS at the grass root level. Clinical and microbiological parameters were also studied alongwith. METHODS Prospective study was conducted in the Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh from October, 2018 to October, 2020.138 sputum smear positive patients were enrolled at the time of initiation of treatment and studied till end of intensive phase (IP). Baseline socio-demographic and clinical details, any adverse drug reactions (ADR's), their subsequent management and sputum smear conversion at end IP were noted. Various patient and disease related factors were studied in relation to sputum smear conversion and ADR's. At end IP, experiences of the patients with the newly introduced daily regimen were assessed by using a structured questionnaire. The data was tabulated and statistically analyzed. RESULTS Mean age of the patients was 39.31 ± 1.5 years. Majority were males, literate, married, employed, from urban background and moderately built. During IP, 59 (42.8%) patients experienced ADR's. 31/59 patients needed admission while 28/59 patients were managed on outpatient basis. 31/59 patients improved with symptomatic management, while 28/59 patients required change in anti tubercular drugs for a short period of time. All the patients were shifted back to FDC daily DOTS after a few days. Though 59 patients reported ADR's, only 44/59 patients missed their doses. Rest 15/59 patients continued with the treatment despite mild ADR's and reported for management without missing any dose. Follow-up smear at end IP was negative in 130/138 patients (94.2%). 93.5% patients preferred their family member as the DOTS provider. More than 90% of the patients were satisfied with basic provisions like treatment room privacy, cleanliness, safe drinking water and sign boards at DOTS centre. Satisfaction with the health care worker (HCW) (assessed by enquiring about the behavior of the HCW, explanation given about the disease and treatment, pre-treatment counseling, occurrence of ADR's, consequences of irregular treatment, warning signs for consultation, advise on nutrition requirement and follow-up information) was reported by 97.8% patients. Sputum conversion rates were significantly higher in unemployed (p = 0.043). Non-adherence to treatment was significantly associated with ADR's (p < 0.001). Sputum conversion rates and ADR's were unaffected by education, rural/urban background, BMI, co-morbidities, addiction and previous history of anti-tubercular treatment. CONCLUSION Daily DOTS achieved appreciable sputum conversion rates at end IP. Non-adherence to treatment and ADR's were managed well with adequate psychosocial support, counseling, timely monitoring and treatment. FDC daily DOTS emerged as a highly acceptable regimen owing to various comprehensive measures adopted at the grass root level.
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Affiliation(s)
- Akshaya Moorthy
- Department of Pulmonary Medicine, Govt. Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Surabhi Jaggi
- Department of Pulmonary Medicine, Govt. Medical College and Hospital, Sector 32, Chandigarh, 160030, India.
| | - Kranti Garg
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, 147001, India
| | - Mandeep Kaur Sodhi
- Department of Pulmonary Medicine, Govt. Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Deepak Aggarwal
- Department of Pulmonary Medicine, Govt. Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Jagdish Chander
- Department of Microbiology, Govt. Medical College & Hospital, Sector-32, Chandigarh, 160030, India
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Kumar MB, Gulati N, Chander J, Singla N, Bhalla M, Nayyar C, Sharma S, Kaur M. Species Distribution and Antifungal Susceptibility Profile of Dermatophytes from a Tertiary Care Centre in North India. J Lab Physicians 2022; 14:449-455. [DOI: 10.1055/s-0042-1748826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Objective Dermatophytoses, one of the most ancient diseases, is becoming a menace in recent times. This has made the knowledge of antifungal susceptibility a priority in today's times.
Material and Methods This is a prospective study conducted over 18 months including all dermatophytes isolated during the period. Dermatophytes were identified by routine phenotypic methods. Antifungal susceptibility testing was performed for griseofulvin, terbinafine, and itraconazole as per the Clinical Laboratory Standard Institute M38 A2, and minimum inhibitory concentrations (MICs) were read after 5 days.
Results Patient details and associated risk factors were recorded. Fixed dose combinations with steroids were associated with 79.3% (46 out of 58) of patients with dermatophytosis of skin. Among the 72 dermatophytes isolated during the study period, 58 (80.5%) were isolated from skin scrapings and 14 (19.4%) from nail samples. Tinea corporis with cruris was the most common presentation. The most common dermatophyte isolated from skin scrapings was Trichophyton mentagrophytes complex (70.6%, 41 out of 58), while from nail samples it was Trichophyton rubrum complex (78.57%, 11 out of 14). Based on the MIC50 and MIC90 results, itraconazole showed the lowest MICs, followed by terbinafine and then griseofulvin.
Conclusion With the changing epidemiology of species distribution and antifungal resistance, there is a need for continuous surveillance of these parameters of dermatophytes.
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Affiliation(s)
- Mani Bhushan Kumar
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Neelam Gulati
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Mala Bhalla
- Department of Dermatology, Venereology and Leprosy, Government Medical College Hospital, Chandigarh, India
| | - Charu Nayyar
- Department of Microbiology, Medanta Hospital, Sriganganagar, Rajasthan, India
| | - Swati Sharma
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Manharpreet Kaur
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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Singla N, Bansal Y, Garg K, Sharma G, Gill M, Chander J. Seroprevalence of hepatitis A and hepatitis E in patients at a teaching hospital of northern India over a period of 8 years. J Family Med Prim Care 2022; 11:567-572. [PMID: 35360807 PMCID: PMC8963652 DOI: 10.4103/jfmpc.jfmpc_1212_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 11/04/2022] Open
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Gupta V, Kaur M, Bora P, Kumari P, Datta P, Gupta R, Chander J. A Prospective Study to Assess the Optimal Incubation Times for Culture and Aerobic Bacterial Profile in Prosthetic Joint Infections. J Lab Physicians 2021; 13:224-230. [PMID: 34602786 PMCID: PMC8478509 DOI: 10.1055/s-0041-1730879] [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] [Indexed: 11/29/2022] Open
Abstract
Introduction
With an increase in the number of total joint arthroplasties, the count of prosthetic joint infections (PJIs) is also increasing and has become a nightmare for an orthopaedic surgeon. Microbiological diagnosis is important for administering definitive antimicrobial treatment. Negative culture reports hamper patient management and prolonged incubation periods have increased the culture yield but at the risk of culture contamination in conventional microbiology settings. Thus, we aimed to optimize the best incubation time for culture and the aerobic bacterial profile of PJIs.
Material and Methods
Over a year, samples from clinically suspected PJI patients were collected and processed for culture using standard techniques. The samples were incubated for up to 10 days with daily subculturing on to solid media. The bacterial isolates were identified and antibiotic susceptibility was performed.
Results
Out of 200 patients, 105 were included in the study and samples were collected in triplicate. In 70 cases culture was positive and 35 were culture negative PJIs. Mean incubation days to culture positivity was 3.6 days with 97.14% culture positivity seen by the seventh day of incubation. Twenty-four percent
methicillin-resistant Staphylococcus aureus
, and more than 50% extended spectrum β lactamase producing
Klebsiella pneumoniae
and
Escherichia coli
were isolated.
Discussion
Culture positivity in PJIs provides definitive evidence of infection and guides the treatment. Increasing the incubation times can help in maximizing the culture yield, and we found that 97.14% pathogens grew within 7 days of incubation. Prolonging it further would not provide an added advantage especially in a resource-constraint setting.
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Affiliation(s)
- Varsha Gupta
- Department of Microbiology, Government Medical College Hospital, Chandigarh, Punjab, India
| | - Mandeep Kaur
- Department of Microbiology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Prapti Bora
- Department of Microbiology, Government Medical College Hospital, Chandigarh, Punjab, India
| | - Pooja Kumari
- Department of Microbiology, Government Medical College Hospital, Chandigarh, Punjab, India
| | - Priya Datta
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Ravi Gupta
- Department of Orthopedics, Government Medical College Hospital, Chandigarh, Punjab, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, Punjab, India
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Sharma S, Datta P, Gupta V, Vasesi D, Chander J. Bacteriological Surveillance of Ambulance Vehicles from a Tertiary Care Hospital of North India. J Lab Physicians 2021; 13:202-207. [PMID: 34602782 PMCID: PMC8481011 DOI: 10.1055/s-0041-1730848] [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] [Indexed: 11/25/2022] Open
Abstract
Objective
An ambulance is a medically equipped vehicle which is used in case of any medical emergency for the transport of patients to treatment facilities. The ambulances help in the transportation of thousands of patients per year, and such patients may carry infectious microorganisms which pose a major threat to the treatment of such patients. In this study, we analyzed the extent of bacterial contamination in our ambulance vehicles and measured the degree of antimicrobial resistance among isolated pathogens.
Material and Method
This study included five ambulances of our tertiary care hospital and different random sites were swabbed in each vehicle. These were selected based on their well-known high frequency of contact by emergency personnel and patients. Swabs were inserted into sterile test tubes containing normal saline and immediately transferred to our microbiology laboratory to identify bacterial contaminants utilizing standard microbiological procedures.
Result
A total of 198 swab samples were collected from all the five ambulances, out of which 170 (85.8%) swabs were sterile and 28 (14.2%) swabs yielded potentially pathogenic bacterial isolates. The highest contamination rate with pathogenic bacteria was detected in the oxygen flow meter knob (60%), suction machine tubing (60%), and stethoscope (40%).
Staphylococcus aureus
(32%) was the most frequently detected microorganism.
Conclusion
Our study showed low prevalence of bacterial contamination in ambulances because of good infection control policy of our hospital, however, some areas still need improvement and require proper standard operating procedures of disinfection policies of these emergency vehicles.
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Affiliation(s)
- Shiwani Sharma
- Department of Microbiology, Gian Sagar Medical College, Rajpura, Punjab, India
| | - Priya Datta
- Department of Medical Parasitology, PGIMER, Chandigarh, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Dipanshu Vasesi
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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Mehta V, Chander J, Gulati N, Singla N, Vasdeva H, Sardana R, Kumar Pandey A. Epidemiological profile and antifungal susceptibility pattern of Trichosporon species in a tertiary care hospital in Chandigarh, India. Curr Med Mycol 2021; 7:19-24. [PMID: 34553093 PMCID: PMC8443878 DOI: 10.18502/cmm.7.1.6179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Revised: 10/20/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Trichosporon species are ubiquitous in nature which are associated with fatal opportunistic invasive infections, especially in immunocompromised patients. The present study aimed to evaluate the epidemiological and clinical details, as well as the antifungal susceptibility pattern of the patients with Trichosporon infections. Materials and Methods In total, 50 clinical isolates of Trichosporon species from various samples were included in this study. The samples were isolated over a period of 18 months from patients in a tertiary hospital in North India. The isolates were characterised phenotypically with Vitek MS (bioMérieux, France). Trichosporon spp. were isolated from urine (30%), nail (30%), tissue (16%), pleural fluid (14%), and sputum (5%). In total, majority of the isolates were of Trichosporon asahii (92%), followed by Trichosporon mucoides (6%), and Trichosporon ovoides (2%). It is noteworthy that most of the reported cases were from intensive care unit (34%). Results Intravenous catheters, antibiotics, and antifungal uptake were significantly associated risk factors with Trichosporon infection. All invasive isolates were observed to be resistant in vitro to caspofungin and exhibited high minimum inhibitory concentration (MIC) values against amphotericin B, fluconazole, and 5-flucytosine. The MICs for voriconazole and posaconazole were low. Conclusion Trichosporonosis is being increasingly reported all around the world, including India. The results of this study highlighted the importance of early detection and treatment for this emerging yeast and also added to the ongoing surveillance for the antifungal susuceptibility pattern for this fungus.
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Affiliation(s)
- Vibha Mehta
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Neelam Gulati
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Hena Vasdeva
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Raman Sardana
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
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Parashar A, Rastogi V, Bhatnagar M, Sharma M, Chander J. An evaluation study of ATR-FTIR spectroscopy (Attenuated total reflectance- Fourier transform) for characterization of Trichosporon species isolated from clinical samples. Indian J Med Microbiol 2021. [DOI: 10.1016/j.ijmmb.2021.08.341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mahajan V, Guglani V, Singla N, Chander J. Spectrum of Multiorgan Dysfunction in Scrub Typhus Infection. J Trop Pediatr 2021; 67:6363912. [PMID: 34480177 DOI: 10.1093/tropej/fmab074] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We planned this study to determine the clinical spectrum and compare incidence of multiorgan dysfunction in children hospitalized with scrub typhus with other etiologies of tropical fever. DESIGN Prospective cohort study. SETTING Pediatric emergency and PICU services of a university teaching hospital situated in the sub-Himalayan region. PATIENT Children aged 2 months to 14 years with acute undifferentiated fever of more than 5 days. INTERVENTIONS Detailed fever workup was performed in all children. We compared scrub typhus IgM positive children (cases) with remaining febrile children who were negative for scrub IgM assay (controls) for mortality and morbidity. MAIN RESULTS We enrolled 224 febrile children; 76 children (34%) were positive for scrub typhus IgM ELISA. Scrub typhus group had a significantly higher incidence of multiorgan dysfunction [OR 3.5 (95% CI 2.0-6.3); p < 0.001] as compared to non-scrub typhus group requiring supportive care. The incidence of altered sensorium [OR 8.8 (95% CI 3.1-24.9)], seizures [OR 3.0 (95% CI 1.1-8.3)], acute respiratory distress syndrome [OR 17.1 (95% CI 2.1-140.1)], acute renal failure (5% vs. 0%), meningitis [OR 6.2 (95% CI 1.2-31.6)], thrombocytopenia [OR 2.8 (95% CI 1.5-5.1)], transaminitis [OR 2.7 (95% CI 1.6-4.8)], requirement of oxygen [OR 17.8 (95% CI 4.0-80.3)], positive pressure support [OR 3.7 (95% CI 1.2-10.5)] and shock requiring inotropes [OR 3.0 (95% CI 1.3-6.7)] was significantly higher in scrub typhus group as compared to the non-scrub typhus group (Table 1). CONCLUSIONS Pediatric scrub typhus who were hospitalized had severe systemic manifestations when compared to other causes of fever.
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Affiliation(s)
- Vidushi Mahajan
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh 160030, India
| | - Vishal Guglani
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh 160030, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College and Hospital, Chandigarh 160030, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh 160030, India
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15
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Bansal VK, Misra MC, Agarwal AK, Agrawal JB, Agarwal PN, Aggarwal S, Aslam M, Krishna A, Baksi A, Behari A, Bhattacharjee HK, Bhojwani R, Chander J, Chattopadhyay TK, Chintamani, Chowbey P, Dalvi A, Dash NR, Dhawan IK, Gamangatti S, Garg PK, Gupta NM, Gupta R, Gupta SK, Gupta V, Kaman L, Kapur BML, Kataria K, Khan M, Khanna AK, Khullar R, Kumar A, Kumar A, Kumar S, Kumar S, Lal P, Maurya SD, Moirangthem GS, Pal S, Panwar R, Parshad R, Pottakkat B, Prajapati OP, Puntambekar S, Ranjan P, Rathore YS, Sahni P, Sarangi R, Seenu V, Sharma R, Shukla VK, Singh DP, Singh J, Singh R, Sinha R, Sikora SS, Srivastava A, Srivastava A, Srivastava KN, Thomas S, Verma GR, Wig JD, Kapoor VK. SELSI Consensus Statement for Safe Cholecystectomy—Prevention and Management of Bile Duct Injury—Part B. Indian J Surg 2021. [DOI: 10.1007/s12262-019-01994-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Singh S, Pal N, Chander J, Sardana R, Mahajan B, Joseph N, Chakrabarti A, Rudramurthy SM, Hariprasath P, Paul S, Kaur H, Ghosh A. Mucormycosis caused by Syncephalastrum spp.: Clinical profile, molecular characterization, antifungal susceptibility and review of literature. Clinical Infection in Practice 2021. [DOI: 10.1016/j.clinpr.2021.100074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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17
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Kaur M, Singla N, Bhalla M, Kundu R, Gulati N, Chander J. Aspergillus candidus eumycetoma with review of literature. J Mycol Med 2021; 31:101135. [PMID: 33873148 DOI: 10.1016/j.mycmed.2021.101135] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Mycetoma is a slowly progressive, chronic granulomatous infection of skin and subcutaneous tissues with involvement of underlying fasciae and bones, usually affecting extremities. In India, among mycetoma, the eumycetoma constitutes about 35% of cases. Hereby, we report the first case of eumycetoma caused by uncommon fungus, Aspergillus candidus. CASE REPORT A 61 year old female presented to the Department of Dermatology with history of swelling of right foot associated with multiple firm nodules of approx. 1.5 × 1.5 cm each over dorsum of foot with discharging sinus containing white color granules. Biopsy of lesion on right foot on direct KOH examination revealed septate hyphae. Histopathology examination showed a histiocytic granuloma with fungal elements. Culture on Sabouraud Dextrose Agar grew white mycelial colonies which were identified to be Aspergillus species phenotypically. Genetic sequencing using Internal transcribed spacer gene, beta tubulin gene and Calmodulin gene was done and the isolate was identified to be Aspergillus candidus. Lesion was excised and patient was started on itraconazole. CONCLUSION Timely identification and starting of antifungal treatment can help in reducing morbidity due to eumycetoma to a large extent. As newer and newer species of fungi are emerging as significant causative agents of human infections, it is pertinent to report such findings from epidemiological point of view.
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Affiliation(s)
- Manharpreet Kaur
- Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, India.
| | - Mala Bhalla
- Department of Dermatology, Government Medical College Hospital, Sector 32-B, Chandigarh, India
| | - Reetu Kundu
- Department of Pathology, Government Medical College Hospital, Sector 32-B, Chandigarh, India
| | - Neelam Gulati
- Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, India
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18
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Gupta V, Sharma S, Pal K, Goyal P, Agarwal D, Chander J. Serratia no longer an opportunistic uncommon pathogen - case series & review of literature. Infect Disord Drug Targets 2021; 21:e300821191666. [PMID: 33618650 DOI: 10.2174/1871526521666210222125215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/06/2020] [Accepted: 12/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Serratia spp. is a common enteric bacterium generally thought not to be pathogenic in the gastrointestinal tract. Serratia marcescens is a member of the genus Serratia, which is a part of the family Enterobacteriales..Of all Serratia species, S. marcescens is the most common clinical isolate and the most important human pathogen. OBJECTIVE We are discussing here four cases of Serratia marcescens which we reported in our laboratory in the Department of Microbiology Government Medical College and Hospital Chandigarh during six months of duration. METHOD All the samples were processed and identified as per standard microbiological techniques.The isolates of Serratia marcescens were identified, depending upon their biochemical and morphological characters and further confirmed by MALDI-TOF-MS ,PGIMER Chandigarh. RESULT In one of the four cases there was polymicrobial infection and one patient was diabetic and rest three patients were immunocompetent. The importance of detection and reporting of Serratia marcescens is related to the concern regarding its increase spread in hospital settings as nosocomial infection . CONCLUSION We need to identify and isolate this pathogen ,not thinking of only contaminant and opportunistic pathogen but as a pathogen which can lead to serious infections in hospital settings .
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Affiliation(s)
- Varsha Gupta
- Department of Microbiology, Government Medical College Hospital, Chandigarh. India
| | - Shiwani Sharma
- Department of Microbiology, Government Medical College Hospital, Chandigarh. India
| | - Kritika Pal
- Department of Microbiology, Government Medical College Hospital, Chandigarh. India
| | - Poonam Goyal
- Department of Obstetrics & Gynecology , Government Medical College Hospital, Chandigarh. India
| | - Deepak Agarwal
- Department of Pulmonary Medicine, Government Medical College Hospital, Chandigarh. India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh. India
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19
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Bansal Y, Singla N, Butta H, Aggarwal D, Gulati N, Chander J. Nocardia Infections: Ten Years Experience from a Tertiary Health Care Center in North India (2007-2016). Infect Disord Drug Targets 2021; 21:445-451. [PMID: 32416708 DOI: 10.2174/1871526520666200516161940] [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: 02/23/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Nocardia species are important cause of infections in humans but are underreported due to missed diagnosis as well as misdiagnosis. Majority of the literature on these infections consists of case reports or series with few articles describing high number of cases. OBJECTIVE To study the epidemiology of Nocardia infections in a tertiary care center. MATERIALS AND METHODS This retrospective observational study was done in a tertiary care centre of North India over a period of 10 years (2007-2016). The detection of Nocardia spp. from clinical specimens was done by conventional methods viz. direct microscopy (Gram's stain, modified Ziehl -Neelsen stain [1%], KOH examination) and culture. RESULTS A total of 25 cases of nocardiosis were diagnosed during the study period. The mean age of the patients was 50.9 years (range 30-72 years) with a male:female ratio of 3:2. The site of disease in these patients included pulmonary (n=18), cutaneous (n=4), perinephric abscess (n=1), ocular (n=1) and bone (n=1). Risk factors associated were underlying lung disease (n=11), smoking (n=7), diabetes (n=5) and steroid therapy (n=4) in pulmonary nocardiosis, iatrogenic (n=1) and leprosy (n=1) in cutaneous nocardiosis, diabetes in perinephric abscess and cataract surgery in ocular nocardiosis. Culture was positive in 12/25 (48%) patients for Nocardia spp. Direct microscopy was positive in 22 patients. We wish to highlight that meticulous observation of KOH wet mount examination helped in clinching the diagnosis of Nocardiosis in 3 cases which were earlier missed by other methods. CONCLUSION Good communication with the clinician alongside a meticulous effort in the laboratory is essential for appropriate diagnosis and management of these cases.
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Affiliation(s)
- Yashik Bansal
- Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, India
| | - Hena Butta
- Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Deepak Aggarwal
- Department of Pulmonary Medicine, Government Medical College Hospital, Sector 32, Chandigarh, India
| | - Neelam Gulati
- Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, India
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20
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Sharma S, Bora P, Singla N, Gupta V, Chander J. Isolation of Morganella Morganii and Providencia Species from Clinical Samples in a Tertiary Care Hospital in North India. Infect Disord Drug Targets 2021; 21:84-89. [PMID: 31994472 DOI: 10.2174/1871526520666200128162646] [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: 09/16/2019] [Revised: 11/06/2019] [Accepted: 12/26/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The members of the tribe Proteeae, Morganella and Providencia are being increasingly recognized as important pathogens. The spectrum of disease caused by them is wide and in reported cases, the mortality is high. Previously both of these pathogens were considered to be rare pathogens as the potential to cause nosocomial transmission and infection was not much studied. But their phenomenal evolution and increase in multidrug-resistance (MDR) strains of these pathogens are posing a major threat toward public health throughout the world. METHODS This present study was carried out from July 2018 to December 2018 on all the pus and body fluid samples that were received in the Department of Microbiology. Samples were processed as per the standard Microbiological guidelines and also were analyzed for their antimicrobial susceptibility profile as per Clinical Laboratory Standards Institute. RESULTS Out of 8425 samples received, 2140 were culture positive, amongst which 19 samples (0.89%) were positive for Providencia species (9) and Morganella morganii(10). The male : female ratio of these 19 patients was 2.8 : 1 and maximum patients (13) belonged to 20-60 years. As far as risk factors are concerned, maximum patients were diabetics (7) followed by abnormal liver function tests (6), concomitant UTI (6), history of invasive procedure (5), prior exposure to antibiotics (5) and urinary catheterization (4). About 6 were polymicrobial infections. Antibiotic susceptibility patterns revealed that Providencia strains were sensitive to ampicillin- sulbactum (77.7%) and amikacin (77.7%), while all Morganella strains were 100% sensitive to tobramycin and piperacillintazobactam. CONCLUSION This study heralds in need for more research in this area as infections caused by these two pathogens are on the rise. Moreover, resistance to antimicrobials is also an increasingly common problem thus delaying the treatment and prognosis of the disease.
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Affiliation(s)
- Shiwani Sharma
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Prapti Bora
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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21
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Singhal L, Goel A, Gupta V, Palta S, Chander J. In vitro evaluation of antibiotic synergy for carbapenem-resistant Klebsiella pneumoniae clinical isolates. Indian J Med Res 2021; 154:520-526. [PMID: 35345078 PMCID: PMC9131782 DOI: 10.4103/ijmr.ijmr_760_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives: The prevalence of severe infections due to carbapenem-resistant Klebsiella pneumoniae (CRKP) strains has increased worldwide. With rising resistance to polymyxins, the treatment has become challenging. Given the paucity of novel agents and limited data on combination therapy for CRKP, the present study was performed to test antibiotic combinations, for synergy against clinical isolates of CRKP. Methods: A total of 50 clinical isolates of CRKP were included. Modified carbapenem inactivation method was performed for the detection of carbapenemases. In vitro synergy testing was done for the following combinations: meropenem+colistin, imipenem+tigecycline and polymyxin B+levofloxacin. It was performed with epsilometric test and microdilution checkerboard method. The time kill assay (TKA) was used to confirm the results. The fractional inhibitory concentration was also calculated. Results: All CRKP isolates (100%) were ESBL producers and were completely resistant to amoxicillin-clavulanic acid, cefepime, cefotaxime, ceftazidime and piperacillin-tazobactam. Resistance to ciprofloxacin, amikacin and tetracycline was 96, 88 and 54 per cent, respectively. Overall, 78 (39/50) and 88 per cent (44/50) of the 50 CRKP isolates exhibited synergy by TKA for meropenem-colistin and imipenem-tigecycline, respectively. No synergy was detected for levofloxacin-polymyxin B combination. The best combination among the three was that of imipenem and tigecycline followed by meropenem-colistin. Interpretation & conclusions: Of the three combinations tested, imipenem and tigecycline followed by meropenem-colistin were found to be best. No synergy was detected for levofloxacin-polymyxin B combination.
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22
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Datta P, Gupta V, Gupta M, Pal K, Chander J. Corynebacterium Striatum, an Emerging Nosocomial Pathogen: Case Reports. Infect Disord Drug Targets 2021; 21:301-303. [PMID: 32091348 DOI: 10.2174/1871526520666200224103405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/30/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
Corynebacterium striatum is an emerging nosocomial pathogen, capable of causing a variety of infections in immunocompromised and hospitalized patients. ; Case Presentation: We describe three cases of infection by C. striatum that were initially considered as contamination. Clinical suspicion in the wake of predisposing factors and accurate identification, using the Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS), were key to implicate this commensal bacterium as a cause of infection.
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Affiliation(s)
- Priya Datta
- Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh, India
| | - Menal Gupta
- Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh, India
| | - Kritika Pal
- Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh, India
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Abstract
The members of the family Pseudomonadaceae have been reorganised under various groups, each with several species and are known as opportunistic pathogens. Pseudomonas mendocina (P.mendocina) formerly known as CDC group Vb-2, belongs to stutzeri group (group II) and was first discovered in 1970 in Mendoza. The present case report is about an overwhelming leg ulcer in an asthmatic and diabetic 53-year-old, Indian farmer following a fall due to a multi-drug resistant strain of P.mendocina without any systemic spread due to timely intervention. Authors emphasise that P. mendocina may be an important emerging pseudomonad or alternatively an under-diagnosed pathogen in immunocompromised patients exposed to soil. The multidrug resistant nature of this organism is alarming and it may become a threat to people with weakened immune systems.
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Gupta V, Pal K, Bhagat A, Goel A, Chander J. Quinolone Susceptibility in Salmonella Isolates Based on Minimum Inhibitory Concentration Determination. J Lab Physicians 2020; 12:263-267. [PMID: 33390675 PMCID: PMC7773437 DOI: 10.1055/s-0040-1721163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction
Typhoid fever, caused by
Salmonella typhi
and
paratyphi
, is a generalized infection with case fatality of about 10%. The symptoms may be severe, with life threatening sequelae of infection in a proportion of cases. Antimicrobial agents are the mainstay of therapy in enteric fever so as to prevent the complications associated with severe illness and mortality in the patients. Fluoroquinolones (e.g., ciprofloxacin) are very effective against completely susceptible
Salmonella
bacteria. However, their efficacy is doubtful once any resistance is detected. Pefloxacin testing has ultimately helped in the accurate identification of quinolone susceptibility for a better therapeutic success rate. In the present study we have tried to evaluate the quinolone susceptibility in
Salmonella
isolates based on minimum inhibitory concentration (MIC) determination.
Materials and Methods
The method used in the study is quinolone susceptibility in
Salmonella
isolates based on MIC determination.
Salmonella
isolates show intermediate susceptibility to ciprofloxacin using disk diffusion. Both ciprofloxacin and pefloxacin MIC evaluation has been done to corroborate the results with pefloxacin disk diffusion testing.
Results
There was a positive correlation between the susceptibility to ciprofloxacin and pefloxacin. However, the isolates with intermediate susceptibility had variations in terms of susceptibility to pefloxacin. MIC values for pefloxacin and our findings suggested that pefloxacin susceptible on disk diffusion as per Clinical and Laboratory Standards Institute guidelines showed lower values for MIC using Pefloxacin HICOMB test and pefloxacin resistant isolates showed higher MIC values.
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Affiliation(s)
- Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Kritika Pal
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Alisha Bhagat
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Anku Goel
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
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Kumari P, Datta P, Gombar S, Sharma D, Chander J. Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India. Trop Doct 2020; 51:162-167. [PMID: 33375896 DOI: 10.1177/0049475520982457] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was Acinetobacter sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.
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Affiliation(s)
- Pooja Kumari
- Post Graduate Student, Department of Microbiology, Government Medical College Hospital, Chandigarh
| | - Priya Datta
- Assistant Professor, Department of Microbiology, Government Medical College Hospital, Chandigarh
| | - Satinder Gombar
- Professor and Head, Department of Anaesthesia and Intensive Care, Government Medical College Hospital, Chandigarh
| | - Deepak Sharma
- Assistant Professor, Department of Community Medicine, Government Medical College Hospital, Chandigarh
| | - Jagdish Chander
- Professor and Head, Department of Microbiology, Government Medical College Hospital, Chandigarh
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Gupta V, Singhal L, Pal K, Bhushan M, Sharma R, Chander J. Fournier's Gangrene Due to Salmonella Typhimurium in a Healthy Male: A Rare Aberrant Infection. Infect Disord Drug Targets 2020; 21:e170721188115. [PMID: 33208080 DOI: 10.2174/1871526520666201117143421] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Human Salmonella infections have been classically distinguished into diseases caused by typhoidal and non-typhoidal salmonella (NTS). Typhiodal salmonella includes S. enterica serovars Typhi and Paratyphi that cause the systemic disease but are restricted to human infections, while NTS consists mainly of other serovars that predominantly cause self-limiting gastroenteritis in humans. Localisation of foci with persisting infection occurs due to dissemination of the bacteria throughout the body and can cause a variety of rare clinical syndromes at aberrant sites. Fournier's gangrene, a rapidly progressive, often fatal, necrotizing fasciitis of the external genitalia and perineum due to Salmonella typhimurium, is a rare manifestation and has never been reported. CASE A 22-year-old male, apparently healthy patient with no relevant past medical history, was presented to surgical emergency with chief complaints of swelling of bilateral scrotal area. Infective etiology was considered and a diagnosis of Fournier's gangrene was made. Pure growth of Salmonella typhimurium was obtained after repeated subculture and was identified biochemically and on serotyping, as Salmonella enterica, Serotype typhimurium using specific antisera. CONCLUSION In our case report, we describe a case of Fournier's gangrene due to Salmonella Typhimurium in an otherwise healthy male to highlight the unusual presentation of Non typhoidal salmonellae at an aberrant site. We also emphasize the importance of using selective media like Selenite F broth for isolation of Salmonella typhimurium from a pus sample.
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Affiliation(s)
- Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh sector 32, India
| | - Lipika Singhal
- Department of Microbiology, Government Medical College and Hospital, Chandigarh sector 32, India
| | - Kritika Pal
- Department of Microbiology, Government Medical College and Hospital, Chandigarh sector 32, India
| | - Mani Bhushan
- Department of Microbiology, Government Medical College and Hospital, Chandigarh sector 32, India
| | - Rajeev Sharma
- Department of General Surgery, Government Medical College and Hospital, Chandigarh sector 32, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh sector 32, India
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Banga S, Azad C, Gupta R, Sawal N, Mahajan V, Chander J, Guglani V. Changing Clinicoradiologic Spectrum of Intracranial Neurotuberculosis in Children: A Cross-sectional Study. J Child Neurol 2020; 35:879-888. [PMID: 32677487 DOI: 10.1177/0883073820938594] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurotuberculosis is among the most severe type of tuberculosis with high mortality and morbidity in all age groups. Various sociodemographic and disease-/treatment-related factors have emerged over the years that can affect clinical and radiologic features of neurotuberculosis. OBJECTIVE To investigate various clinical and neuroradiologic presentations of neurotuberculosis. METHODOLOGY This cross-sectional study was done in a tertiary care center of northern India. The patients between the ages of 3 months and 18 years with newly diagnosed neurotuberculosis were enrolled after taking informed consent. RESULTS A total of 78 patients (37% males) were enrolled. Fifty-six patients (72%) had tubercular meningitis (TBM) and 22 (28%) isolated tuberculomas. Very high percentage of patients in both the groups was BCG vaccinated. In the tubercular meningitis group, fever (68%), headache (59%), and vomiting (54%) were the most common complaints whereas in the tuberculoma group, seizures (95.5%) were the main complaint and systemic symptoms were rare. In tubercular meningitis patients, cerebrospinal fluid-based studies showed cartridge-based nucleic acid amplification test (Xpert MTB/RIF) positivity for Mycobacterium tuberculosis in 17.6% cases, whereas on gastric aspirate and sputum examination, acid-fast bacilli were seen in 30.7% and cartridge-based nucleic acid amplification test was positive in 19% patients. On neuroimaging, hydrocephalus was seen in 44.6% of tubercular meningitis patients, infarcts in 32%, and basal exudates in 12% patients only; coexistent tuberculomas were seen in 53%. CONCLUSION Compared with the available literature, the present study showed a smaller percentage of children <5 years of age, stage III tubercular meningitis cases, and typical neuroradiologic findings like hydrocephalus and basal exudates and more tuberculomas associated with tubercular meningitis.
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Affiliation(s)
- Sumiti Banga
- Department of Pediatrics, 29746Government Medical College and Hospital, Chandigarh, India
| | - Chandrika Azad
- Department of Pediatrics, 29746Government Medical College and Hospital, Chandigarh, India
| | - Rekha Gupta
- Department of Radiodiagnosis, 29746Government Medical College and Hospital, Chandigarh, India
| | - Nishit Sawal
- Department of General Medicine, 29746Government Medical College and Hospital, Chandigarh, India
| | - Vidushi Mahajan
- Department of Pediatrics, 29746Government Medical College and Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, 29746Government Medical College and Hospital, Chandigarh, India
| | - Vishal Guglani
- Department of Pediatrics, 29746Government Medical College and Hospital, Chandigarh, India
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Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Jillwin J, Iyer R, Sharma A, Harish BN, Roy I, Kindo AJ, Chhina D, Savio J, Mendiratta D, Capoor MR, Das S, Arora A, Chander J, Xess I, Boppe A, Ray U, Rao R, Eshwara VK, Joshi S, Patel A, Sardana R, Shetty A, Pamidimukkala U. Characteristics, outcome and risk factors for mortality of paediatric patients with ICU-acquired candidemia in India: A multicentre prospective study. Mycoses 2020; 63:1149-1163. [PMID: 32681527 DOI: 10.1111/myc.13145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The epidemiology, clinical profile and outcome of paediatric candidemia vary considerably by age, healthcare settings and prevalent Candida species. Despite these differences, few comprehensive studies are undertaken. This nationwide study addresses this knowledge gap. METHODS 487 children who contracted ICU-acquired candidemia at 23 Indian tertiary care centres were assessed for 398 variables spanning demography, clinical characteristics, microbiology, treatment and outcome. RESULTS Both neonates (5.0 days; range = 3.0-9.5) and non-neonatal children (7.0 days; range = 3.0-13.0) developed candidemia early after ICU admission. Majority of neonates were premature (63.7%) with low birthweight (57.1%). Perinatal asphyxia (7.3%), pneumonia (8.2%), congenital heart disease (8.4%) and invasive procedures were common comorbidities, and antibiotic use (94.1%) was widespread. C tropicalis (24.7%) and C albicans (20.7%) dominated both age groups. Antifungal treatment (66.5%) and removal of central catheters (44.8%) lagged behind. Overall resistance was low; however, emergence of resistant C krusei and C auris needs attention. The 30-day crude mortality was 27.8% (neonates) and 29.4% (non-neonates). Logistic regression identified admission to public sector ICUs (OR = 5.64), mechanical ventilation (OR = 2.82), corticosteroid therapy (OR = 8.89) and antifungal therapy (OR = 0.22) as independent predictors of 30-day crude mortality in neonates. Similarly, admission to public sector ICUs (OR = 3.62), mechanical ventilation (OR = 3.13), exposure to carbapenems (OR = 2.18) and azole antifungal therapy (OR = 0.48) were independent predictors for non-neonates. CONCLUSIONS Our findings reveal a distinct epidemiology, including early infection with a different spectrum of Candida species, calling for appropriate intervention strategies to reduce candidemia morbidity and mortality. Independent factors identified in our regression models can help tackle these challenges.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Sood
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead, New South Wales, Australia
| | - Joseph Jillwin
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Indranil Roy
- Calcutta Medical Research Institute, Kolkata, India
| | | | | | | | | | | | - Shukla Das
- University College of Medical Sciences, Delhi, India
| | - Anita Arora
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | - Appalaraju Boppe
- PSG Institute of Medical Sciences and Research, Coimbatore, India
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Singhal L, Gupta V, Gupta M, Goel P, Chander J. Identification and Sensitivity of Vaginal and Probiotic Lactobacillus species to Urinary Antibiotics. J Lab Physicians 2020; 12:111-114. [PMID: 32905311 PMCID: PMC7467827 DOI: 10.1055/s-0040-1716604] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives Healthy vaginal microbiota is mainly dominated by Lactobacillus species namely L. crispatus , L. gasseri , L. jensenii , and L. iners . Lactobacilli are thought to play an important role in the prevention of urogenital infections, and Lactobacillus probiotics to restore and/or maintain vaginal health has been advocated. These can interfere with the adherence, growth, and colonization by uropathogenic bacteria, thus reducing the risk of urinary tract infection (UTI). This study aims to isolate and evaluate the susceptibility of healthy vaginal and probiotic Lactobacillus spp. to urinary antibiotics. Materials and methods A total of 50 premenopausal, nonmenstruating women with no symptoms of vaginal infection or UTI or antimicrobial use in the past 2 weeks were enrolled. Two high vaginal swabs were collected for Nugent's scoring and anaerobic culture. Colonies yielding gram-positive rods were confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Lactobacillus strains in a vaginal probiotic tablet were also isolated, and the sensitivity of both sets to urinary antibiotics was determined. Results A total of 29 Lactobacillus spp. were isolated, including L. crispatus (15), L. gasseri (5), L. vaginalis (4), L. paracasei (2), L. curvatus (1), L. fermentum (1), and L. paraplantarum (1). All strains were susceptible to nitrofurantoin and resistant to norfloxacin, gentamicin, and cotrimoxazole (except L. paracasei ). The probiotic strains were pan-sensitive. Conclusions Prophylactic antibiotics are capable of eliminating the normal vaginal inhabitants, which may increase the probability of UTI. The administration of vaginal probiotics as an alternate or multidrug therapy can restore vaginal microbiota and help prevent recurrent UTI.
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Affiliation(s)
- Lipika Singhal
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Menal Gupta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Poonam Goel
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
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Mohan N, Kaur M, Singhal L, Saini V, Chander J. An Experience with Delamanid in an XDR TB Case - Case Report. Infect Disord Drug Targets 2020; 21:637-639. [PMID: 32691718 DOI: 10.2174/1871526520666200720113711] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/22/2020] [Accepted: 05/31/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Tuberculosis is an endemic infection and a serious public health problem in India. India constitutes one-fourth of the global TB population. The emerging drug resistance is a major threat to global tuberculosis care and control. CASE REPORT We present a case of newly diagnosed microbiologically confirmed, extremely drugresistant primary pulmonary tuberculosis which was treated with Delamanid and was found to be cured of tuberculosis. DISCUSSION Delamanid is a new anti-tubercular drug, which is thought to primarily inhibit the synthesis of methoxy-mycolic, and keto-mycolic acid, which are components of the mycobacterial cell wall. In our patient who was a newly diagnosed case of MDR-TB converted to XDR-TB in little course of time and we were successful in treating him with Delamanid therapy. His sputum culture conversion was achieved in 20 days. Even though the patient did not tolerate well because of the side effects of the drug, still he became microbiologically negative for tuberculosis. CONCLUSION Delamanid fulfills many target criteria for new TB drugs and may be particularly useful for the treatment of MDR-TB. It can be administered orally and its bactericidal properties make it suitable in regimens designed to shorten treatment duration. Clinical efficacy data, while limited, are reassuring.
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Affiliation(s)
- Nimitha Mohan
- Department of Microbiology, Government Medical College Hospital-32, Sector 32, Chandigarh, India
| | - Manharpreet Kaur
- Department of Microbiology, Government Medical College Hospital-32, Sector 32, Chandigarh, India
| | - Lipika Singhal
- Department of Pulmonary Medicine, Government Medical College Hospital-32, Sector 32, Chandigarh, India
| | - Varinder Saini
- Department of Microbiology, Government Medical College Hospital-32, Sector 32, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital-32, Sector 32, Chandigarh, India
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Gupta V, Singh M, Datta P, Goel A, Singh S, Prasad K, Chander J. Detection of various beta-Lactamases in Escherichia coli and Klebsiella sp.: A study from Tertiary Care Centre of North India. Indian J Med Microbiol 2020; 38:390-396. [PMID: 33154252 DOI: 10.4103/ijmm.ijmm_20_253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 11/04/2022]
Abstract
Objective The emergence of carbapenem-resistant Escherichia coli and Klebsiella species is a global threat. We aimed to compare two phenotypic methods and evaluate the genotypic method for the detection of beta-lactamases produced by E. coli and Klebsiella spp. Materials and Methods One hundred and twenty-six E. coli and Klebsiella isolates were examined for phenotypic production of beta-lactamases by using disc diffusion, combined disc test (CDT) and modified carbapenem inactivation method (mCIM). All strains were also studied for the presence of various genes by polymerase chain reaction. Results Out of 126 isolates, 96% of the isolates were extended-spectrum β-lactamase (ESBL) producers based on the presence of various ESBL genes. CDT method showed higher number of total (89%) carbapenemases in comparison to mCIM (81%). Among carbapenemases none of the isolates were Klebsiella pneumoniae carbapenemase producer by CDT, while 69% isolates were metallo-beta-lactamase (MBL) producers. Another method, mCIM/ethylene diamine tetraacetic acid mCIM showed 100% agreement for MBL detection. As regards, AmpC and class D carbapenemases; 0.04% and 16% positivity was detected, respectively, based on CDT method. Molecular analysis revealed 91% of the isolates harbouring carbapenemase genes. blaNDMwas the most common gene detected followed byblaOXA-48. Nine of the blaNDM-positive isolates also possessed blaOXA-48gene. Conclusion Our finding shows high percentages of ESBL and carbapenemases in E. coli and Klebsiella spp. Among phenotypic methods, CDT seems to be a better choice as prevalence of carbapenemases shows lots of variation in our country. For Class B enzymes, both CDT and mCIM/eCIM can be used in the routine laboratories.
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Affiliation(s)
- Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Meenakshi Singh
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Priya Datta
- Department of Microbiology, Government Medical College and Hospital; Department of Parasitology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anku Goel
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Sanjay Singh
- Department of Microbiology, Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kashinath Prasad
- Department of Microbiology, Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
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Sharma S, Datta P, Gupta V, Kumari P, Kaur G, Chander J. Characterization of Bacteriological Isolates from Patients and Environment Samples of Burn Ward: A Study from a Tertiary Care Hospital of India. Infect Disord Drug Targets 2020; 21:238-242. [PMID: 32516105 DOI: 10.2174/1871526520666200609120659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Source of infection in a burn patient is from the patient's flora, contaminated environmental surfaces and transmitted from health care workers. Insufficiently disinfected hospital environmental surface provides a niche for multidrug resistant bacteria. This study was carried out to assess the bacteriological profile of the pathogens from burn wounds and the surrounding environmental areas. METHODS During 6 months, wound swabs from burn patients were collected on admission (after 48 hours of admission), on day 5 and then weekly. Environmental samples were also collected from burn ward and studied for the bacteriological and anti-microgram profiles. RESULTS Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii were the major bacterial isolates from the wound swabs and the environmental samples. ESBL was detected in 56.6% of our Enterobacteriaceae isolates. The environmental sites from which these bacterial isolates were found were nursing counter, sink, dressing trolley, medicine locker and patient's bed. The percentage of MRSA decreased from 50 to 5% and there was an increased role of Enterococci species causing infections (13.63%). CONCLUSION In this study, there appears that the colonizers of the environment may play a role in the causation of infection in burn patients. In burns ward, rigorous implementation of infection control program should be warranted, which includes and hygiene and use of personal protective equipment, environmental disinfection, cohort nursing care and antibiotics stewardship programme.
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Affiliation(s)
- Shiwani Sharma
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Priya Datta
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Pooja Kumari
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Gursimran Kaur
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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Singhal L, Bhagat A, Gupta M, Gulati N, Dalal AK, Chander J. Multiple Recalcitrant Draining Sinuses Caused by Mycobacterium mageritense Following Laparoscopic Cholecystectomy: a Case Report and Brief Review of Literature. Jpn J Infect Dis 2020; 73:256-258. [DOI: 10.7883/yoken.jjid.2019.343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Singla N, Mahajan V, Chander J, Guglani V. Clinicoepidemiological and Genotyping Correlation of Pediatric Scrub Typhus from Chandigarh, India. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1782-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Singla N, Mahajan V, Chander J, Guglani V. Clinicoepidemiological and Genotyping Correlation of Pediatric Scrub Typhus from Chandigarh, India. Indian Pediatr 2020; 57:314-316. [PMID: 32284475] [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: 06/11/2023]
Abstract
OBJECTIVE We studied the clinical phenotypes and prevalent genotypes of Orientia tsutsugamushi in our area using indirect immunofluorescence assay (IFA). METHODS We prospectively screened all febrile children presenting to our hospital over three years. From among children who were scrub typhus positive by ELISA we selected a sample of convenience for IFA testing to determine the genotypes of O. tsutsugamushi using four strains namely Boryong, Gilliam, Karp and Kato. RESULTS Of all scrub positive patients (n=77), we tested 14 samples using IFA and all 14 samples were IFA positive. Karp genotype (n=7) was most prevalent followed by Kato (3), Boryong (1) and Gilliam (1) genotypes; 2 patients were positive for mixed genotype. There was high prevalence of organ dysfunction among IFA positive children. Three most common organ dysfunctions included hematological derangement in all, liver involvement in 10 (71%), and encephalopathy and shock in 4 each. CONCLUSIONS Karp was the most prevalent genotype of O. tsutsugamushi in our area.
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Affiliation(s)
- Nidhi Singla
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Vidushi Mahajan
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India. Correspondence to: Dr Vidushi Mahajan, Assistant Professor, Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, India.
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Vishal Guglani
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
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Datta P, Chander J, Gupta V, Mohi GK, Attri AK. Evaluation of various risk factors associated with multidrug-resistant organisms isolated from diabetic foot ulcer patients. J Lab Physicians 2020; 11:58-62. [PMID: 30983804 PMCID: PMC6437817 DOI: 10.4103/jlp.jlp_106_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS: Diabetic foot ulcer is a dreaded complication of diabetes. Diabetic foot ulcer patients are often infected with multidrug resistant organism (MDRO) due to chronic course of the wound, inappropriate antibiotics treatment, frequent hospital admission, neuropathy, nephropathy, and peripheral vascular disease. MATERIALS AND METHODS: This prospective study was conducted in our 750 bedded hospital for a period of 6 months. The present study was undertaken to isolate various MDRO methicillin resistant Staphylococcus aureus; Gram-negative bacteria producing enzymes such as extended spectrum beta-lactamases (ESBL), Amp C, Carbapenamases; Pseudomonas and Acinetobacter species producing metallo-beta-lactamases (MBL). In addition we attempted to identify risk factors for association of diabetic foot ulcer and MDRO. RESULTS: A total of 149 bacterial isolates were identified. Of the total isolates 73.2% were Gram-negative and remaining 26.8% were Gram-positive bacteria. Among Enterobacteriaceae 59% were ESBL producers and 48% were Amp C producers. In addition, 41.5% of the isolates produced both ESBL and Amp C and 13.4% were carbapenem resistant Enterobacteriaceae. Among 20 Pseudomonas and Acinetobacter isolates, 5 were MBL producers (25%). Furthermore, in the study, 56% of patients with diabetic foot ulcer harbored MDRO. The risk of multidrug-resistant infection is significantly more in patients having diabetes duration >20 years and size of ulcer more than 4 cm2. CONCLUSION: The detection of MDRO in patients of diabetic foot ulcer changes the treatment strategies limits the antimicrobial options and causes higher complications among them.
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Affiliation(s)
- Priya Datta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Gursimran Kaur Mohi
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Ashok K Attri
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
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Kundu R, Handa U, Punia RS, Singla N, Chander J, Attri AK. Phaeohyphomycosis: Cytomorphologic Evaluation in Eleven Cases. Acta Cytol 2020; 64:406-412. [PMID: 32203955 DOI: 10.1159/000506432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/20/2019] [Accepted: 02/11/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide which causes a wide variety of clinical manifestations. STUDY DESIGN A retrospective analysis of 11 cases diagnosed with fungal inflammation on cytology over a period of 6 years (2013-2018) was done along with culture/histopathologic confirmation. RESULTS Of the total of 11 cases, 9 cases presented with subcutaneous swellings and 1 case each with brain and lung lesions. The age range was 30-83 years (mean: 53.6); 8 patients were male and 3 were female. Cytologic smears showed fungal profiles with septate tortuous hyphae, as well as swollen and narrow, yeast-like swellings with an irregular breadth of the hyphae in all cases. The fungal profiles were visualized on a Masson-Fontana stain. The background showed inflammatory cells, giant cells, and necrosis in variable proportions. Five cases were diagnosed as phaeohyphomycosis on cytology, whereas 3 cases were misdiagnosed as aspergillus and 2 as candida. In 1 case, typing of the fungus was not done. Histopathology was available in 5 cases, and in all these a diagnosis of phaeohyphomycosis was reached. Ten of the 11 cases had confirmation on fungal culture. CONCLUSIONS Phaeoid fungi are rarely seen in routine cytologic practice. Careful evaluation of cytologic smears and an awareness of the characteristic morphologic features of phaeohyphomycosis are helpful in arriving at a correct diagnosis. Fine needle aspiration cytology provides a rapid diagnosis, enabling prompt therapy.
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Affiliation(s)
- Reetu Kundu
- Government Medical College and Hospital, Chandigarh, India,
| | - Uma Handa
- Government Medical College and Hospital, Chandigarh, India
| | | | - Nidhi Singla
- Government Medical College and Hospital, Chandigarh, India
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Bansal Y, Singla N, Kaistha N, Sood S, Chander J. Molecular identification of Fusarium species complex isolated from clinical samples and its antifungal susceptibility patterns. Curr Med Mycol 2020; 5:43-49. [PMID: 32104743 PMCID: PMC7034782 DOI: 10.18502/cmm.5.4.2149] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background and Purpose: More than 300 Fusarium species are grouped into approximately 23 species complexes out of which around 70 are involved in human infections. The nomenclature of these species has undergone considerable changes in recent years. These species cause localized infections in individuals while inducing systemic infections mainly in immunocompromised patients. The present study was conducted to identify Fusarium species in clinical isolates by molecular methods and determine their in vitro minimum inhibitory concentration (MIC) patterns to address the lack of data in this domain in Northern India. Materials and Methods: For the purpose of the study, Fusarium isolates obtained from various clinical samples were sent to the Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands, for molecular identification. The MIC testing was performed using the microbroth dilution method as per the Clinical and Laboratory Standards Institute reference method (M38-A2). Results: Fusarium was isolated from 33 patients (i.e., 1, 1, 2, 14, and 15 cases with endophthalmitis, sinusitis, pulmonary involvement, onychomycosis, and keratitis, respectively). These 33 isolates belonged to three species complexes, namely F. solani species complex (FSSC; n=13), F. fujikuroi species complex (FFSC; n=13), and F. incarnatumequiseti species complex (FIESC; n=7). The species identified within FSSC, FFSC, and FIESC included F. keratoplasticum (n=6)/F. falciforme (n=6)/F. solani (n=1), F. proliferatum (n=7)/F. sacchari (n=5)/F. anthophilum (n=1), and F. incarnatum SC species (n=6)/F. equiseti SC species (n=1), respectively. The MIC results showed that all isolates had a lower MIC against amphotericin B than against the other antifungal agents.
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Affiliation(s)
- Yashik Bansal
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Neelam Kaistha
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Sunandan Sood
- Department of Ophthalmology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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Bora P, Datta P, Gupta V, Singhal L, Chander J. Characterization and antimicrobial susceptibility of coagulase-negative staphylococci isolated from clinical samples. J Lab Physicians 2020; 10:414-419. [PMID: 30498314 PMCID: PMC6210844 DOI: 10.4103/jlp.jlp_55_18] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This study has been done to speciate coagulase-negative staphylococci (CoNS) and also study their antibiotic susceptibility pattern isolated from clinical samples. MATERIALS AND METHODS A total of 120 consecutive CoNS were isolated from various clinical samples such as blood, pus, wound swab, drain fluid, tracheal aspirate, peritoneal fluid, and pleural fluid over a period of 6 months. CoNS were identified by characteristic growth on media such as Blood agar and MacConkey agar. Speciation and identification were done by a range of biochemical testing such as PYR broth hydrolysis, novobiocin resistance, polymyxin B sensitivity, and then by matrix-assisted laser desorption ionization-time of flight. Antibiotic susceptibility of the isolates was done by Kirby-Bauer disk diffusion method as per CLSI 2017 guidelines. RESULTS Among the 120 isolates, the most common species was Staphylococcus epidermidis (56.67%) followed by Staphylococcus haemolyticus (21.67%), Staphylococcus lugdunensis (11.67%), Staphylococcus caprae (5%), Staphylococcus cohnii (3.33%), and finally Staphylococcus vitulinus (1.67%). Good in vitro susceptibility was noted toward linezolid (100%), vancomycin (100%), teicoplanin (100%), and doxycycline (80.2%). The antibiotics to which resistance was seen were penicillin (96.5%), ciprofloxacin (57.1%), and oxacillin (45.5%). MR CoNS in our study ranged from 50% to 68.67%. CONCLUSION Antibiotic resistance in CoNS is increasing toward penicillin, ciprofloxacin, and oxacillin as found in our study. The antibiotics such as vancomycin, teicoplanin, linezolid, and doxycycline which showed good in vitro susceptibility, therefore, should be kept as reserve drugs and used judiciously.
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Affiliation(s)
- Prapti Bora
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Priya Datta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Lipika Singhal
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
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Abstract
The safe and sustainable management of biomedical waste (BMW) is social and legal responsibility of all people supporting and financing health-care activities. Effective BMW management (BMWM) is mandatory for healthy humans and cleaner environment. This article reviews the recent 2016 BMWM rules, practical problems for its effective implementation, the major drawback of conventional techniques, and the latest eco-friendly methods for BMW disposal. The new rules are meant to improve the segregation, transportation, and disposal methods, to decrease environmental pollution so as to change the dynamic of BMW disposal and treatment in India. For effective disposal of BMWM, there should be a collective teamwork with committed government support in terms of finance and infrastructure development, dedicated health-care workers and health-care facilities, continuous monitoring of BMW practices, tough legislature, and strong regulatory bodies. The basic principle of BMWM is segregation at source and waste reduction. Besides, a lot of research and development need to be in the field of developing environmental friendly medical devices and BMW disposal systems for a greener and cleaner environment.
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Affiliation(s)
- Priya Datta
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Gursimran Kaur Mohi
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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Abstract
The rise in carbapenemases-producing organisms has challenged the scientific community. Infections caused by these bacteria have limited treatment options. There are various types such as Klebsiella pneumoniae carbapenemase (Ambler class A), metallo-beta-lactamases of VIM-type, IMP-type, NDM-type (Ambler class B), and OXA-48-types (Ambler class D). An efficient strategy for detection of carbapenemase producers is important to determine the appropriate therapeutic modalities. In this study, four methods - Carba NP test, modified Carba NP (MCNP) test, carbapenem inactivation method (CIM) test, and Rapidec Carba NP kit test were evaluated. We evaluated an in-house MCNP test to detect carbapenemase production using a single protocol which gave reliable results. Furthermore, CIM using routine antibiotic discs gives good results. Both these tests were found to be cost-effective.
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Affiliation(s)
- Varsha Gupta
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Ranu Soni
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Neha Jain
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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Gupta V, Garg R, Kumaraswamy K, Datta P, Mohi GK, Chander J. Phenotypic and genotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae from blood culture specimens: A study from North India. J Lab Physicians 2020; 10:125-129. [PMID: 29692574 PMCID: PMC5896175 DOI: 10.4103/jlp.jlp_155_16] [Citation(s) in RCA: 4] [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: 01/26/2023] Open
Abstract
BACKGROUND: Emergence of carbapenem resistance among Enterobacteriaceae in different geographical regions is of great concern as these bacteria are easily transmissible among patients. Carbapenem-resistance in Enterobacteriaceae is due to production of carbapenemases of various classes and hyper production of the ESBLs (Extended spectrum beta lactamases) and Amp C beta lactamases with reduced cell wall permeability mechanisms. Phenotypic detection and differentiation is important for proper infection control and appropriate patient management. This study was done to know the prescence of various beta lactamases and carbapenemases with other mechanisms of resistance in Klebsiella pneumoniae isolates. MATERIALS AND METHODS: 50 non-duplicate carbapenem resistant isolates of Klebsiella pneumoniae from blood culture specimens were included and various mechanisms of resistance were studied based on phenotypic and genotypic methods. RESULTS: Out of 50 isolates, 39 (78%) of K. pneumoniae isolates were Extended Spectrum Beta Lactamase (ESBL) producers based on CLSI guidelines. All 50 showed positive Modified Hodge Test (MHT) and 32 showed Metallo Beta Lactamase (MBL) by Combined Disc Test (CDT). Four isolates showed AmpC production with porin loss. None of the isolates showed Class A KPC production by CDT. In our study all the 10 isolates evaluated by genotypic technique produced CTX-M group 1 enzyme by multiplex PCR. Seven out of 10 strains which showed positive MBL results were positive for NDM. CONCLUSIONS: Carbapenems are often considered last resort antibiotics in the treatment of infections due to multidrug-resistant organisms. It is therefore mandatory to maintain the clinical efficacy of carbapenems by early detection of various enzymes. For routine clinical laboratories both phenotypic and genotypic tests need to be followed to detect various mechanisms of carbapenem resistance and this is of epidemiological relevance also.
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Affiliation(s)
- Varsha Gupta
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Ritu Garg
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | | | - Priya Datta
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Gursimran Kaur Mohi
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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Kaur M, Chander J, Singla N, Das A, Sood S, Guarro J. Sino-orbital infection caused by Schizophyllum commune - rare presentation of a basidiomycetous fungus. J Mycol Med 2020; 30:100934. [PMID: 32037101 DOI: 10.1016/j.mycmed.2020.100934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/24/2022]
Affiliation(s)
- M Kaur
- Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh 160030, India.
| | - J Chander
- Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh 160030, India
| | - N Singla
- Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh 160030, India
| | - A Das
- Department of Otorhinolaryngology, Government Medical College Hospital, Chandigarh 160030, India
| | - S Sood
- Department of Ophthalmology, Government Medical College Hospital, Chandigarh 160030, India
| | - J Guarro
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Reus, Spain
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Gupta V, Gulati N, Sharma S, Gupta R, Soni A, Chander J. Linezolid Resistance in Staphylococcus haemolyticus - Case Series and Review of Literature. Infect Disord Drug Targets 2020; 20:713-717. [PMID: 31389316 DOI: 10.2174/1871526519666190807152850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/24/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Coagulase negative Staphylococci (CoNS) are important. The common antibiotics used for the treatment of the infections caused by CoNS are penicillin, oxacillin, ciprofloxacin, clindamycin, erythromycin, gentamicin, and vancomycin. Linezolid is an oxazolidinone group of antibiotic with activity against Gram-positive bacteria. It is used for the treatment of serious infections caused by Gram-positive bacteria resistant to other antibiotics, including streptococci, vancomycin-resistant enterococci (VRE). AIMS AND OBJECTIVE This study emphasizes on the judicious use of newer antibiotics to contain the spread of resistance. METHOD We are discussing five cases of Linezolid resistant Staphylococcus Haemolyticus which were reported in our laboratory during one year from patients with device related infections and also review of literature is being presented for an update. RESULT In our study, the isolates were resistant to other groups of antimicrobials but susceptible to glycopeptides. All the isolates were methicillin-resistant. CONCLUSION Linezolid is approved as an alternative drug to be given for catheter-related bloodstream infections. In earlier studies, linezolid-resistant staphylococci have been reported increasingly all over the world. This study is to create awareness amongst clinicians that improper and excessive use of linezolid will make this antibiotic-resistant and thus will be of no help in future, so judicious and relevant use of antibiotics needs to be emphasized.
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Affiliation(s)
- Varsha Gupta
- Govt. Medical College and Hospital Microbiology, Chandigarh, India
| | - Neelam Gulati
- Govt. Medical College and Hospital Microbiology, Chandigarh, India
| | - Shiwani Sharma
- Govt. Medical College and Hospital Microbiology, Chandigarh, India
| | - Ravi Gupta
- Govt. Medical College and Hospital Microbiology, Chandigarh, India
| | - Ashwani Soni
- Govt. Medical College and Hospital Microbiology, Chandigarh, India
| | - Jagdish Chander
- Govt. Medical College and Hospital Microbiology, Chandigarh, India
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Singhal L, Kumari P, Gupta M, Garg K, Chander J. Submandibular Lymphadenitis in an Immunocompetent Female: Microbiological Confirmation is Need of the Hour. Infect Disord Drug Targets 2020; 20:929-931. [PMID: 31218965 DOI: 10.2174/1871526519666190619150549] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Non-tuberculous mycobacterial (NTM) infections have been drawing interest recently because of their rising incidence not only in immunocompromised but also in immunocompetent individuals. These are underdiagnosed in India, due to the lack of awareness and a low index of suspicion. In regions endemic for tuberculosis (TB) such as India, presumptive anti-tubercular treatment (ATT) is often prescribed. Non-response of NTM to the treatment may be wrongly ascribed to multidrug-resistant tuberculosis. This emphasizes the need to correctly identify them before initiating therapy. CASE STUDY We describe the case of a young, healthy female patient who developed cervical lymphadenitis and was given presumptive ATT. Microbiological examination of aspirate revealed M. fortuitum. This not only rectified the course of treatment resulting in complete cure, but also spared the patient from significant side effects of ATT. This case is an awakening call for clinicians to avoid presumptive ATT.
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Affiliation(s)
- Lipika Singhal
- Department of Microbiology, Government Medical College and Hospital, Sector- 32, Chandigarh, India
| | - Pooja Kumari
- Department of Microbiology, Government Medical College and Hospital, Sector- 32, Chandigarh, India
| | - Menal Gupta
- Department of Microbiology, Government Medical College and Hospital, Sector- 32, Chandigarh, India
| | - Kranti Garg
- Department of Pulmonary Medicine, Government Medical College and Hospital, Sector- 32, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Sector- 32, Chandigarh, India
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Singh T, Arya SK, Handa U, Chander J. Usability of donor corneas harvested from the deceased having septicaemia or malignancy. QJM 2019; 112:681-683. [PMID: 31199485 DOI: 10.1093/qjmed/hcz143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/30/2019] [Indexed: 11/14/2022] Open
Abstract
CONTEXT There is a wide gap between supply and demand in relation to healthy corneal grafts. Specific contraindications like infection and malignancy lead to non-usage of many grafts, despite the fact that deeming graft unhealthyness for these two contraindications is debatable. AIMS This study was conceptualized to assess if corneas donated from the deceased with septicaemia or malignancy can be deemed fit for implantation. SETTINGS AND DESIGN Retrospective histopathological and microbiological analysis of cadaveric donor corneas. METHODS A total of 76 donor corneas from 38 patients rejected for corneal transplantation in view of patient having septicaemia or malignancy were analysed for pathological and microbiological workup, to look for dissemination of disease within corneal tissue. Pathology workup included gross and microscopic histopathological evaluation of tissue. Microbiology workup included Grams stain and KOH with calcofluor mount, culture in blood agar, chocolate agar, Sabourauds dextrose agar and Mc Conkeys broth. RESULTS A total of 46 donor corneas of 23 septicaemia patients when evaluated showed presence of culture positive infection in 18 patients (78.2%). Histopathological examination done for 30 donor corneas from 15 cancer patients did not reveal presence of tumour cells in the specimen. Corneas of two of cancer patients having septicaemia revealed growth on cultures. CONCLUSIONS Corneal tissues harvested from septicaemia donors showed significantly higher incidence of corneal contamination, confirming their unsuitability for usage. However, there was no incidence of tumour transmission in corneal tissues of the patients with malignancies, suggesting that they can be considered for ophthalmic purpose.
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Affiliation(s)
| | | | | | - J Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
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Bhankhur D, Singla N, Aggarwal D, Chander J. Prevalence of allergic bronchopulmonary aspergillosis among patients with severe bronchial asthma in a tertiary care hospital in Northern India. INDIAN J PATHOL MICR 2019; 62:111-113. [PMID: 30706871 DOI: 10.4103/ijpm.ijpm_205_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The link between fungi and asthma has been known for centuries. About one-third to one-half of severe asthmatics has history of atopic sensitization to filamentous fungi, most predominantly to Aspergillus fumigatus. Allergic bronchopulmonary aspergillosis (ABPA) is the one of the most documented fungal presentations among patients with asthma. This study was done on 50 patients with severe asthma who were consecutively enrolled from January 2016 to June 2017 to look for prevalence of ABPA. Materials and Methods Blood samples were collected from 50 patients with severe asthma, and serum was separated to test for absolute eosinophil count, total IgE, and Aspergillus fumigates-specific IgE. Results The prevalence of ABPA was found to be 70% (35/50). Of these, ABPA-B (ABPA with bronchiectasis) was less 31.4% (11/35) when compared with 68.5% (24/35) of patients with serological ABPA. Out of these 35 patients, there were 18 females and 17 were males. The mean age of the patients was 41.3 years. Conclusion ABPA prevalence is high in patients with severe asthma, and there is a need to look for and evaluate this association further.
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Affiliation(s)
- D Bhankhur
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - N Singla
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - D Aggarwal
- Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India
| | - J Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
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Sharma P, Bhalla M, Thami GP, Chander J. Evaluation of efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis. J DERMATOL TREAT 2019; 31:749-753. [PMID: 31030594 DOI: 10.1080/09546634.2019.1612835] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: There has been an alarming increase in recalcitrant dermatophytosis in recent years. The standard treatment guidelines no longer seem effective in achieving clearance and results in high failure rates.Objective: To evaluate the efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis.Methods: Clinically diagnosed and KOH positive patients of tinea corporis/cruris/faciei were randomly divided into three groups and given terbinafine 250 mg, itraconazole 200 mg and a combination of both once daily taken on the same day respectively for 3 weeks. Partial responders at the end of the therapy were given same treatment for additional 3 weeks. Clinical parameters namely itching, erythema, and scaling were evaluated at baseline, 3, 6, and 9 weeks. Adverse effects were noted at the end of therapy.Results: Maximum clinical and mycological cure was achieved in group III (receiving combination therapy) (90%) followed by group II (receiving itraconazole) (50%) and group I (receiving terbinafine) (35%). The combination therapy of oral terbinafine and itraconazole was found to be as safe as monotherapy without any significant adverse effects.Conclusions: The combination of systemic terbinafine and itraconazole therapy may be an effective and safe therapeutic strategy in the management of dermatophytosis.
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Affiliation(s)
- Priyanka Sharma
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - Mala Bhalla
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - Gurvinder P Thami
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
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Datta P, Gupta M, Kumari P, Gupta V, Narang S, Chander J. Post-Traumatic Endophthalmitis Due to Acinetobacter radioresistens: Virulence Potential of Commensal Bacteria. Infect Disord Drug Targets 2019; 20:556-558. [PMID: 30674268 DOI: 10.2174/1871526519666190123145321] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/18/2019] [Accepted: 01/21/2019] [Indexed: 11/22/2022]
Abstract
Acinetobacter species are widely distributed in soil, water and hospital environment. In addition to A. calcoaceticus-baumannii complex, the clinically most relevant species, there are other genomospecies which are less frequently identified, mostly due to lack of accurate methods for routine identification. We describe the first case of post-traumatic endophthalmitis caused by otherwise non-pathogenic A. radioresistens, in India. Gram-negative coccobacilli were observed on Gram stain and culture of vitreous fluid specimen, and identified biochemically as Acinetobacter spp. The species was identified by Matrix Assisted Laser Desorption Ionization- Time of Flight Mass Spectrometry (MALDI-TOF MS). The pathogenic potential of 'commensal' A. radioresistens and its role in dissemination of carbapenem resistance genes underlines the importance of species-level identification in Acinetobacter infections.
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Affiliation(s)
- Priya Datta
- Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Menal Gupta
- Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Pooja Kumari
- Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Varsha Gupta
- Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Subina Narang
- Department of Ophthalmology, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Jagdish Chander
- Government Medical College and Hospital, Sector 32, Chandigarh, India
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Seidel D, Meißner A, Lackner M, Piepenbrock E, Salmanton-García J, Stecher M, Mellinghoff S, Hamprecht A, Durán Graeff L, Köhler P, Cheng MP, Denis J, Chedotal I, Chander J, Pakstis DL, Los-Arcos I, Slavin M, Montagna MT, Caggiano G, Mares M, Trauth J, Aurbach U, Vehreschild MJGT, Vehreschild JJ, Duarte RF, Herbrecht R, Wisplinghoff H, Cornely OA. Prognostic factors in 264 adults with invasive Scedosporium spp. and Lomentospora prolificans infection reported in the literature and FungiScope®. Crit Rev Microbiol 2019; 45:1-21. [DOI: 10.1080/1040841x.2018.1514366] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Danila Seidel
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Arne Meißner
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Ellen Piepenbrock
- Department of Immunology and Hygiene, Institute for Medical Microbiology, University of Cologne, Cologne, Germany
| | - Jon Salmanton-García
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Partner site Bonn - Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
| | - Sibylle Mellinghoff
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Axel Hamprecht
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Luisa Durán Graeff
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Philipp Köhler
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Partner site Bonn - Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
| | - Matthew P. Cheng
- Division of Infectious Diseases and Department of Medical Microbiology, McGill University Health Centre, Montreal, Canada
| | - Julie Denis
- Hôpitaux Universitaires, Department of Parasitology and Mycology, Plateau Technique de Microbiologie, FMTS, Université de Strasbourg, Strasbourg, France
| | - Isabelle Chedotal
- Oncology and Hematology Department, University Hospital of Strasbourg and INSERM U1113, Strasbourg, France
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | | | - Ibai Los-Arcos
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Monica Slavin
- University of Melbourne, Melbourne, Australia, The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Maria Teresa Montagna
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppina Caggiano
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Mihai Mares
- Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University, Iași, Romania
| | - Janina Trauth
- Medical Clinic II – Infectious Diseases, University Hospital Giessen/Marburg, Giessen, Germany
| | - Ute Aurbach
- Laboratory Dr. Wisplinghoff, Cologne, Germany
| | - Maria J. G. T. Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Partner site Bonn - Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Partner site Bonn - Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Rafael F. Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Raoul Herbrecht
- Oncology and Hematology Department, University Hospital of Strasbourg and INSERM U1113, Strasbourg, France
| | - Hilmar Wisplinghoff
- Department of Immunology and Hygiene, Institute for Medical Microbiology, University of Cologne, Cologne, Germany
- Laboratory Dr. Wisplinghoff, Cologne, Germany
- Institute for Virology and Clinical Microbiology, Witten/Herdecke University, Witten, Germany
| | - Oliver A. Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Partner site Bonn - Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
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