Ascaris lumbricoides is one of the commonest human parasitic infestations in the developing world. Most of the ascaris infections are asymptomatic and clinical disease ismainly restricted to subjectswith heavywormload. Biliary migration of the wormcan lead to a wide variety of clinical syndromes and concomitant complications necessitating early diagnosis andmanagement. Various disease presentations include biliary colic, obstructive jaundice, acalculous cholecystitis, choledocholithiasis, pancreatitis, cholangitis, biliary strictures and hepatic abscesses. While laboratory tests are non-specific, radiological investigations demonstrate features highly suggestive of biliary ascariasis. The vast majority of patients respond to conservative measures. Endoscopic therapy is necessary in cases which fail to respond to conservative measures or in patients presenting with complicated disease. Worms visible at the ampulla may be extracted endoscopically prior to attempting more intrusive forms of therapy. Sphincterotomy should be avoided for worm extraction since an open biliary sphincter facilitates future disease recurrences should worm reinfestation occur. Recurrence of the disease is frequent due to re-infestations. Wormeradication with anti-helminthic therapy is essential after biliary disease resolution.
Backround & Objective: Clostridium difficile associated disease (CDAD) is a matter of grave concern in the hospital environments due to antimicrobial usage.
Methods: We investigated the clinical and demographic profile of patients whose fecal sampleswere received in our laboratory and correlated the same with their C. difficile toxin (CDT) status. Six hundred twenty nine consecutive and non-repeat fecal samples were subjected to CDT assay using purified anti-toxin A and anti-toxin B coated to latex beads. Semi-quantitative titrations were carried out with the positive samples with a doubling dilution method. Clinical and demographic profile of each patient was recorded. During analysis the patients were assigned to two groups (i) Group 1 comprised of those receiving antibiotics and/or other drugs and (ii) Group 2 of those not receiving any drug.
Results: The age of the patients ranged froma few days to 93 years. Predominant clinical symptoms were diarrhoea (98.7%), abdominal pain (35.9%) and fever (49.8%). CDT was positive in 45.8%with titers ranging from 1 in 5 to 1 in 2560. CDT positivity was highly influenced by prior antibiotic and drug intake (p<0.05). Fever was present in 43.4%and abdominal pain in 35.5%of CDT positive cases. CDT positivitywas also significantly associated with age below 2 years (p<0.001) and between 41-55 years (p<0.01). CDT positivitywas highly associated with gastrointestinal diseases (32.5%) and age.
Interpretation & conclusion: Readily available clinical and basic laboratory data are useful for correlation with severity of CDAD.
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Lahori M, Rishi P, Tiwari RP. Stability of antimicrobial activity of cryptdin-2 against selected pathogens under physiological conditions. J Gastrointest Infect 2012; 2 (1):30-37.
Background and Objective: An initial step prior to clinical development of any therapeutically active peptide is to evaluate its stability under physiological conditions. As cationic antimicrobial peptides have been reported to lose their activity under physiological conditions, present study was done to evaluate the stability of antimicrobial activity of cryptdin-2 (a Paneth cell antimicrobial peptide) against Salmonella Typhimurium, Yersinia enterocolitica and Staphylococcus aureus in the presence and absence of physiological concentrations of bile salts, monovalent and divalent cations, trypsin as well as at various p H values.
Methods: The antimicrobial activity of cryptdin-2 under various physiological conditions against Salmonella Typhimurium NCTC 74, Yersinia enterocolitica and Staphylococcus aureus was evaluated by use of a modified broth dilution technique
Results: Interestingly, the activity of the peptide against the Gramnegative strainswas augmented by bile salts while no change in the activity against S. aureus was observed. Though there was a decrease in activity with increasing concentrations of metal ions, the activity was not completely lost. The peptide was able to sustain its activity against all the three test strains at physiological concentrations of trypsin. At p H8, no change in activitywas observed against Y. enterocolitica and S. Typhimurium while it was found to be reduced against S. aureus.
Interpretation and Conclusion: The study provides data showing the stability of the peptide under the physiological conditions and indicates towards the possibility of developing it as an alternate strategy to combat bacterial pathogens.
Background and Objectives: The clinical profile of hepatorenal syndrome (HRS) patients admitted in a tertiary care hospital of Punjab was studied.
Methods: In this prospective study all the patients of chronic liver disease with renal involvement fulfilling the International Ascites Club criteria of HRS were evaluated over a period of one and a half year.
Result: Forty-two patients were diagnosed to have HRS and were included in the study. The incidence of HRS was 0.275%of hospitalmedical admissions. Alcoholic cirrhosis was the etiology in 71.5%of patients. Most of the patients of HRS received a combination of dopamine, albumin and terlipressin. Themortality ratewas found to be approximately 60%. Variables amongst survival versus non-survival groups were analyzed. Oliguria and hepatic encephalopathy weremore predominant in non-survival group. Serumbilirubin, hypoalbuminemia, hyponatremia, coagulopathy and urine osmolalitywas higher in non-survival group. Patients with Child-Pugh Score less than 10 had a better survival.
Conclusion: The poor prognostic factors in non-survival group were presence of ascites, severe jaundice, hepatic encephalopathy, alcohol abuse, hypoalbuminemia, progressive renal failure and a Child-Pugh Score > 10. Thus, HRS is not uncommon and needs proper diagnosis and prompt treatment to ensure better outcome.
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Gupta V, Kaur D, Kaushal V. Relationship between serum Hepatitis B virus (HBV) DNA levels and HBe Ag status in patientswith Hepatitis B virus infection. J Gastrointest Infect 2012; 2 (1):43-45.
Background: Hepatitis B is one of the most common types of viral hepatitis in the world. For the last thirty years, only serological markers and liver function test have been utilized to monitor the disease progression and treatment response until the emergence of molecular detection methods. Hepatitis B V DNA quantitation is used extensively world wide for the diagnosis andmonitoring of treatment of Hepatitis B virus (HBV) infection. The aim of this study was to quantitate HBV–DNA by Real time PCR method and to compare the results with HBe Ag detection in Hepatitis B patients.
Material and Methods: Seventy one serumsamples of patients with hepatitis (all HBs Ag positive) were the subjects of this study. Serum HBV DNA of all these samples was detected by COBAS Taq Man real time PCR and HBe Ag by ELISA.
Results: Amongst Hepatitis B group patients, serum HBV DNA was detected in 61 out of 71 patients (85.9%). HBe Ag was positive in 21% of patients (15/71). Majority of the HBe Ag positive patients had a significantly higher serum HBV DNA levels than HBe Ag negative patients.
Conclusion: HBe Ag status did not necessarily reflect HBV-DNA level in the serum, as 46/71 (64.7%) in the Hepatitis B group were positive for HBV DNA but negative for HBe Ag.
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Gupta V, Chhina RS, Singh R, Suri P, Singh J, Chopra P. Seroprevalence of Parenterally and Enterally Transmitted Hepatitis Viruses in a Tertiary Care Hospital of North India -ATwo Year Study. J Gastrointest Infect 2012; 2 (1):46-51.
Background & Objectives: Viral hepatitis is one of the major health concerns in developing countries like India. The present study was undertaken to find out the prevalence of hepatitis B, hepatitis C, hepatitis Aand hepatitis E in our area and to compare it with National and International data.
Methods: A total of 34,551 serumsamples received over a period of two years (Jan 2010 to Dec 2011) fromvarious wards and intensive care units (ICUs) were processed in the Department of Microbiology for different markers of viral hepatitis. Out of these, 13,570 serum samples were tested for the presence of HBs Ag, 13,566 for anti HCV antibodies, 3,871 for anti HAV Ig Mand 3,584 for anti HEV Ig Mantibodies by enzyme linked immunosorbent assay (ELISA).
Results: The percentage positivity for hepatitis B, hepatitis C hepatitis Aand hepatitis E was 5.95%, 13.25%, 6.32% and 15.43%respectively in 2010 and 5.62%, 14.27%, 6.56%and 23.53%respectively in 2011. The overall prevalence of viral hepatitis was more in males as compared to females.
Interpretation & Conclusion: The prevalence of hepatitis C was more than hepatitis B among the parenterally transmitted viruses while the prevalence of hepatitis E was more than hepatitis Ain enterally transmitted viruses, in both the years making them a major public health problem in our area.
Acute diarrhea is a common problem in children in developing countries like India leading to hospitalization. The objective of the studywas to assess the etiological agents causing diarrhea in children and their sensitivity patterns to various antimicrobials. This study was carried out from January 2007- December 2009 on 860 pediatric patients attending the out patients department or admitted in thewards of Lok Nayak Hospital, New Delhi with gastroenteritis. Eight hundred and sixty stool samples were collected and examined for various pathogens.
Enteric pathogens were isolated from 321 (37.2%) samples. Parasitic pathogens were observed in 67 (7.79%) stool samples. V.cholerae was the most commonly isolated bacteria 134/321 (41.74%), followed by Shigella 90/321 (28.03%) and E.coli 86 (27.79%). Salmonella spp. (1.5%) and Aeromonas hydrophila (1.86%) were isolated less frequently. Resistance to amoxycillin was observed in 99% of Vibrio, 95% of E. coli, 58% of Shigella and 20% of Salmonella species. Variable degree of resistance ranging from 0% in Salmonella to 69% in E. coli was observed against ciprofloxacin, while resistance to nalidixic acid was observed in more than 90% of all types of bacterial pathogens. Resistance to ceftriaxone, cefotaxime and gentamicin was less common. Identification of the etiological agent of diarrhea in children is very important as it can help in the institution of appropriate therapy and the reduction ofmorbidity andmortality in these patients.
Leptospirosis is a zoonotic disease with worldwide distribution. There is paucity of data about prevalence of this disease in North India. Thus, this studywas undertaken to estimate the seroprevalence of leptospirosis in our region. A total of 3179 blood samples frompatients suspected of leptospirosis were subjected to Ig MELISA (Pan Bio). The seroprevalence of leptospirosis in our area was found to be 20.7%.
Rajoo S Chhina,
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Singh K, Chhina RS, Gupta R, Kaur A, Kaur D, Suri P. Sensitivity pattern of Salmonella serotypes from a tertiary care hospital of Punjab. J Gastrointest Infect 2012; 2 (1):59-61.
Enteric fever is classically caused by S. Typhi & S. Paratyphi A, B & C and it is known to be endemic in India. For optimal patient care, precise information on antibiotic susceptibility pattern is required. Hence, this studywas undertaken to know the antimicrobial sensitivity profile of Salmonella serotypes isolated fromblood in a tertiary care hospital of Punjab. All the blood samples received from January 2010 – December 2011 were processed by automated blood culture systems (BACTEC 9240/Bac T-Alert 3D). Identification and antimicrobial susceptibility pattern of Salmonella strains was studied by automated identification system (Micro Scan Walk-Away/ VITEK 2). Out of a total of 35854 blood samples, 5234 (14.6%) samples were found to be positive for bacterial growth, of which 363 (6.93%) were Salmonella spp. Of these, 281 (77.4%) were S. Typhi and 82 (22.6%) were S. Paratyphi A. Only 2 (0.7%) isolates of S. Typhi were found resistant to ampicillin and trimethoprim-sulfamethoxazole, and 5 (1.8%) were resistant to ciprofloxacin & levofloxacin. All the S. Typhi isolates were sensitive to 3rd generation cephalosporins. S. Paratyphi A isolateswere sensitive (100%) to all the drugs, except trimethoprim-sulphamethoxazole (97.6%) & ceftriaxone (98.8%). Though multi drug resistant Salmonella are being reported fromvarious parts of India, in our region the Salmonella isolates are still susceptible to the commonly used drugs.
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Sharma K, Appannanavar S, Kumar S, Sharma M. Post operative Mycobacterium fortuitum infection following laparoscopic inguinal hernia repair: A case report. J Gastrointest Infect 2012; 2 (1):62-64.
Rapidly growing mycobacteria (RGM) are ubiquitous in nature and are associated with opportunistic nosocomial infections requiring prolonged and multiple antibiotics. Here we report a PCR confirmed case of M. fortuitum complex infection in a post laproscopic inguinal hernia repair using prolene mesh. To the best of our knowledge we have for the first time evaluated the role of PCR using specific primers for the diagnosis of M. fortuitum complex both fromclinical samples and fromculture isolate. A 62 year old physician developed low grade fever and pain over the right iliac fossa after an inguinal hernia repair. Mycobacteriological investigation revealed M. fortuitum infection. Subsequently using specific primer, M. fortuitum complex DNAwas demonstrated both in clinical sample and culture isolate. Patient was startedwith clarithromycin, doxycycline and streptomycin. Thus, PCR is a promising tool for the rapid diagnosis of difficult to treat infections caused by M. fortuitum complex.