Background and objectives: Clostridium difficile is the etiological agent of healthcare-associated infections in adults. Recently, C. difficile is being considered as a gastrointestinal pathogen in pediatric patients. A retrospective investigation was carried out in a tertiary care hospital to look for the pediatric prevalence of C. difficile infection (CDI) in different age groups.
Materials and methods: The patient population investigated for CDI was categorized into infant group (0–2 years), early childhood group (<2–12 years) and teenage group (<12–19 years). Clinical and demographic information were retrieved from laboratory records.
Results: A data of 1033 patients (0–19 years; M:F = 667:366) the male gender was significant (p < 0.0001). Statistical significance (p < 0.0001) was observed between the three age groups (infant group, n = 241; early childhood group, n = 424; teenage group, n = 368). The major underlying ailments were gastrointestinal symptoms (31.9%) and malignancies (24.2%). C. difficile toxin (CDT) was positive in 22.07%, and significant (p = 0.000) in all the groups. Clinical symptoms were bloody diarrhea (9.87%), watery diarrhea (57.31%), fever (53.05%) and abdominal pain (34.56%). The frequency of diarrhea was significant (p > 0.0001). Antibiotic use with clinical symptoms showed significance with watery diarrhea (p = 0.000) and fever (p = 0.000). Abdominal pain was found to be significant (p = 0.007) when correlated with CDT positivity. The CDI was positive in a total of 46 (27%) patients on first follow-up (n = 170). When variables of patients in the repeat follow-up (n = 47) were compared with their primary admission data and that of first follow-up, significant difference was seen.
Conclusion: The CDI is commonly present in hospitalized pediatric patients, but clinical symptoms and suspicion can aid the final diagnosis.
Rajoo S Chhina,
How to cite this article:
Goyal O, Kaur D, Chhina RS, Gupta R. Fluoroquinolone Resistance among Salmonella enterica Serovar Typhi and Paratyphi Isolates in a Tertiary Care Hospital in Northern India. J Gastrointest Infect 2018; 8 (1):12-15.
Background and objectives: Enteric fever, caused by Salmonella enterica serovar S. Typhi and enterica serovar Paratyphi A, B and C is a major health problem worldwide. A progressive increase in antibiotic resistance has been reported among these organisms recently. This study aimed to estimate the prevalence of fluoroquinolone resistance among S. Typhi and S. Paratyphi isolates from a tertiary care hospital in northern India.
Materials and methods: This retrospective study included Salmonella isolates obtained from the blood samples received in microbiology laboratory from January to December 2017. Blood specimens were processed using an automated blood culture system (BACTEC 9240/Bac-T-Alert). Antimicrobial susceptibility testing to ciprofloxacin and levofloxacin was performed using a fully automated Vitek-2 system.
Results: A total of 376 Salmonella enterica isolates were obtained; 294 (78.2%) were identified as S. Typhi, and 82 (21.8%) as S. Paratyphi A. Incidence of ciprofloxacin-resistant strains of S. Typhi was 67.3% and that of S. Paratyphi A was 97.6%. Another 32.6% of S. Typhi and 2.4% S. Paratyphi A isolates showed decreased susceptibility to ciprofloxacin (MICs 0.25 -0.5 ìg/mL). For levofloxacin, 25.8% of S. Typhi and 51.2% of S. Paratyphi A were resistant. Another 73.5% of S. Typhi and 48.8% of S. Paratyphi A isolates showed decreased susceptibility to levofloxacin (MICs 0.25–1 ìg/mL).
Interpretation and conclusion: The incidence of S. Typhi and S. Paratyphi A isolates showing resistance or reduced susceptibility towards fluoroquinolone is very high in northern India.
Sungtila T Jamir,
Amir M Khan,
Narendra P Singh
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Saha R, Grover H, Singh M, Jamir ST, Saxena B, Khan AM, Singh NP. Transmission of Enteropathogens through Fresh Herbs and Method of using them as Safe Condiments. J Gastrointest Infect 2018; 8 (1):22-27.
Background and objectives: As an indispensable dietary component, fresh fruits and vegetables, which are often consumed raw, have been reported to harbor large microbial populations often culminating in enteric disease outbreaks. The present study aimed to assess the microbial quality of coriander and mint and find the efficacy of potassium permanganate (KMnO4) in effectively removing such microbes.
Materials and methods: Ten grams each of fresh, unstored green coriander (n = 50) and mint (n = 50) samples were examined for their parasitic and bacterial content before and after washing with tap water and with an aqueous solution of 0.001% KMnO4. The different species of bacteria, as well as their main burden in these herbs, were also estimated along with the parasites they harbored.
Results: Only 22% unwashed herbs harbored parasites which were reduced to a significant number on washing with tap water. One hundred percent of the herb samples before washing, and 98% of tap water washed herb samples were contaminated with bacteria. A total of 33 different species of bacteria were isolated, from members of the family Enterobacteriaceae (56.3%) Pseudomonadaceae (15.6%), Vibrionaceae (9.4%,), and Acinetobacteriaceae (6.2%). These bacteria were significantly removed after treatment with KMnO4.
Conclusion: The study reveals the presence of harmful enteric bacteria and parasites in fresh green coriander and mint which are liable to cause enteric diseases. We recommend that all the fresh produce which is consumed raw should be treated with 0.001% KMnO4 after tap water washing to render them safe for consumption.
Rajoo S Chhina,
Introduction: Cirrhosis of the liver is associated with increased morbidity and mortality. There is paucity of data on the etiological profile of cirrhosis in Punjab. The purpose of this study was to evaluate the etiological profile of liver cirrhosis in adults in a tertiary care institute in northern India.
Materials and methods: This study included all adult patients with cirrhosis admitted to the Gastroenterology unit of a tertiary care institute in northern India from January 2013 to December 2016. The diagnosis of cirrhosis was made based on the clinical, radiological, biochemical, and/or histological criteria. Patients with incomplete etiological workup were excluded.
Results: A total of 716 hospitalized patients with cirrhosis were included. The mean age of patients was 54 ± 9.3 years (18–82 years), and male:female ratio was 5.7:1. Most common etiologies of cirrhosis were: alcohol (49.2%; n = 352), hepatitis C virus (HCV) infection (29.4%; 211), and nonalcoholic fatty liver disease (NAFLD) (13.6%; 98). Hepatitis B virus (HBV) infection was identified in 3.9% (n = 28) patients only. Other uncommon causes of cirrhosis were: autoimmune (n = 8; 1.1%), Wilson’s disease (n = 5; 0.7%), celiac disease (n = 3; 0.4%), Budd–Chiari syndrome (BCS) (n = 1; 0.1%), and cryptogenic (n = 10; 1.4%).
Conclusion: In this study, alcohol and HCV infection were the most common causes of cirrhosis. Preventive measures are urgently required to control these factors to decrease morbidity and mortality.
Human body is basically composed of human and microbial cells. The microbial cells outnumber the human cells by 10 fold. These microbes are an integral part of human body residing on mucosal and skin surfaces. In this way, we have got two genomes. The gastrointestinal tract is the most significant niche for majority of the microbiota. Gut is considered as a huge fermenter producing a variety of metabolites/products affecting human health. Such products may be beneficial or harmful. Apart from different metabolic products, the microbes are speculated to be the trainers of the immune cells. Therefore, a particular time-point of colonization by specific type of microbes decides the fate of immunity, whether protective or detrimental. Dysbiosis may lead to a variety of metabolic, autoimmune and infectious diseases. In this review, we have focused on the issue of gut microbiota and its possible role in causation of different types of diseases, e.g., autoimmunity, asthma, obesity, etc. Further, we have looked into what can be done to modify this genome in favor of good health with change in diet, antibiotics, probiotics, bacteriophages, exercise, Ayurvedic Panch Karma-like practices, etc.
Intestinal trematode infections are of significant public health importance in endemic areas, especially in Southeast Asia. The epidemiological studies are scarce and asymptomatic infections are usually not recorded. In India, the hospitalbased reports, mainly from Bihar, Uttar Pradesh, West Bengal and Assam, reveal that the intestinal trematodes of human pathogenic importance are Fasciolopsis buski, Metagonimus species, and Gastrodiscoides hominis. Fasciolopsiasis due to F. buski is the most prevalent infection. The clinical diagnosis is presumptive and is usually confirmed by the examination of faecal samples and/or following endoscopy examination. The diagnostic challenges are low sensitivity of direct microscopy techniques and accurate species identification. Evaluation of multiple samples and application of sensitive techniques may reveal a higher positivity. The complications and extraintestinal manifestations following infection are also underestimated. In endemic areas, high worm load following repeated infections leads to complications, such as intestinal obstruction and perforation. Extraintestinal manifestations may involve spine, brain, kidneys, and the myocardium. If left untreated, the infection may cause significant morbidity and mortality. Praziquantel is the drug of choice and nitazoxanide therapy has also been reported effective for treatment. The reports indicating the implementation and effectiveness of any control strategies are lacking. The formulation and implementation of control strategies need to be based on a holistic approach, keeping in view multiple key factors, such as awareness of the infection and its complications, polyparasitism, population at risk, and zoonotic/aquatic transmission. A well-designed integrated program may simultaneously prevent multiple infections in addition to the intestinal trematode infections.
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Gunjan D, Sharma V. Acute Pancreatitis as a Precipitant of Acute-on-chronic Liver Failure in a Patient with Underlying Hepatitis C-related Cirrhosis. J Gastrointest Infect 2018; 8 (1):46-47.
A 66-year-old male, had coronary artery disease and diabetes mellitus, presented with acute onset epigastric pain with radiation to back. He had non-bilious vomiting of 4 days duration. Initial blood investigation showed elevated serum amylase. Abdominal imaging revealed gallstones, edematous pancreatitis with per-pancreatic fat stranding, and evidence of chronic liver disease. Further etiological work-up for chronic liver disease showed anti-hepatitis C virus (HCV) reactivity. Small varices were detected on upper gastrointestinal endoscopy. During hospitalization, he developed ascites, non-cholestatic jaundice, and hepatic encephalopathy. Ascitic fluid analysis showed evidence of spontaneous bacterial peritonitis and serum-ascites albumin gradient of 1.8 g/dL. He was treated with intravenous antibiotics and syrup lactulose and discharged with the advice for maintaining salt restricted diet and was initiated on diuretics. Biliary acute pancreatitis acting as a precipitant for acute-on-chronic liver failure (ACLF) is an uncommon event. This case highlights acute pancreatitis as a noninfectious and nonhepatic insult to precipitate ACLF in previously unknown chronic liver disease related to HCV.
Evolving resistance in pathogenic bacteria has compromised the efficacy of current antibiotics. The need of the hour dictates producing antibiotics to which the bacteria cannot produce resistance. Attractive options possible are first, formulating ‘evolution-proof’ antibiotics via mutation or horizontal gene transfer which bacteria cannot resist and secondly by producing compounds to which resistance may develop, but rarely at a rate that can make it become epidemic.