Dengue in pregnancy:an under-reported illness,with special reference to other existing co-infections

Objective:To keep the level of awareness high as far as incidence of dengue among pregnant women is concerned.Methods:A total of 300 blood samples of patients with fever in pregnancy were received in the Department of Microbiology to rule out dengue infection(January 2011 to December 2012).The samples were put up for presence of dengue IgM antibodies and NS1 Ag by ELISA.The patients who turned out to be positive for dengue serology were retrospectively analysed with respect to patient's age.gestational age.clinical presentation,complications,platelet counts and maternal as well as foetal outcomes.Results:Out of 300 females tested.22(7.3%) were found positive for dengue infection during the said lime period.Out of them 9 were positive for IgM antibodies against dengue and 10 were found to be positive for NS1 Ag.while 3 were positive for both IgM antibody and NS1 Ag.Five patients presented with dengue in first trimester.9 in second trimester and 8 in third trimester.Two patients had coinfections.Patient with coinfection of dengue with malaria had intrauterine death of fetus at 37 weeks while the second one having dengue with typhoid had a preterm vaginal delivery at 35 weeks.Conclusions:Establishing diagnosis of dengue infection in pregnancy is important for effective management by the obstetricians particularly the mode of delivery due to the potential risk of hemorrhage for both the mother and the newborn.Coinfections seen in endemic areas may be more common than usually reported.

Metallo-β-lactamase producing nonfermentative gram-negative bacteria:An increasing clinical threat among hospitalized patients

Objective:To detect and evaluate the various methods for metallo-β-lactamases(MBL) production in Pseudomonas aeruginosa(P.aeruginosa) and Acinetobacter species.Methods:A total of 109 P.aeruginosa and 85 Acinetobacter species were screened for imipenem resistance by Kirby- Bauer disc diffusion methods.Detection of MBL production was(lone by imipenem-EDTA combined disc test,double disc synerygy test(DDST) and imipenem-EDTA MBL E test.Results: A total of 63(57.8%) strains of P.aeruginosa and 46(54.1%) strains of Acinetobacter spp.were found to be resistant to imipenem.Of the 63 imipenem resistant P.aeruginosa tested for MBL production.44(69.89;) were found to be positive and among 46 imipenem resistant Acinetobacter. 19(41.3%) were shown to be the MBL producers.Conclusions:Imipenem-EDTA combined disc test and MBL E test are equally effective for MBL detection in both P.aeruginosa and Acinetobacter spp.,but given the cost-constraints,combined disc can be used as a convenient screening method in the clinical microbiology laboratory.

Outbreak of Salmonella Typhi enteric fever in sub-urban area of North India:A public health perspective

Outbreaks of enteric fever are a major health concern not only due to significant human morbidity and mortality but also fear of spread of multidrug resistant strains.We report an outbreak of enteric fever caused by Salmonella enterica serotype Typhi in a suburban area,in city Chandigarh of North India.Twenty-seven strains of S.typhi were isolated from blood cultures over a period of two weeks with 18 of these 27 patients residing in the same area.Maximum cases were in the age group 5-14 years(10 patients,55.5%) while 4(22.2%) cases were children under 5 years.All the strains showed similar resistogram being resistant to ampicillin and nalidixic acid,intermediate to ciprofloxacin and sensitive to chloramphenicol,ceftriaxone,cefotaxime,cotrimoxazole and azithromycin on disc diffusion testing.Minimum inhibitory concentration of ciprofloxacin was determined by agar dilution method and was found to be raised(≥2μg/mL).This nalidixic acid resistant S.typhi outbreak report warrants the necessity of implementing stringent sanitation practices in public health interest.

Linezolid resistant Staphylococcus haemolyticus:First case report from India

Linezolid is being increasingly used in the treatment of infections with gram-positive organisms especially methicillin resistant Staphylococcal isolates.Though resistance to this antimicrobial is emerging but it is extremely rare.Here we document first case of linezolid resistant Staphylococcus haemolyticus(S.haemolyticus) from India.This organism was isolated from pus oozing from a postsurgical site in 61 year old male hailing from an adjoining state of Haryana.

Salmonella-Salmonellosis-Rare presentations of a common pathogen

Salmonella are most commonly associated with gastroenteritis and enteric fever in humans. Occasionally,dissemination of bacilli throughout the body results in establishment of localized foci of persistent infection especially in patients with debilitating diseases and immunosuppressive states.Infection at various aberrant sites due to Salmonella has been reported relatively seldom.It has perfected the art of intracellular survival in niches from where they can cause myriad of effects.Six cases with Salmonella infection at unusual sites without any preexisting or underlying disease diagnosed over a period of two years are presented here.Salmonella etiology was not suspected in these patients and the diagnosis was made microbiologically only after culture isolation.

Spectrum of fungal keratitis: clinicopathologic study of 44 cases

AIM: To determine the causative agents of fungal keratitis and study the predisposing factors over a period of ten years in a single tertiary care hospital. ·METHODS: A retrospective analysis of fungal corneal ulcers was done from 2003-2012. Patients’ clinical data were noted from the file records. Correlation of histopathological diagnosis was done with the report on fungal culture. · RESULTS: Mycotic keratitis was established in 44 cases by a positive fungal culture. Direct microscopic examination of potassium hydroxide(KOH) mounts revealed fungal elements in 39 cases while 40 cases showed fungus on Gram stained smears. Males(54.55%) were more commonly affected than the females(45.45%). The age ranged from 18 to 82 years. Most common age group to be involved was 41-60 years. Predisposing risk factors were seen in 34(77.27%) cases. Most common findings on clinical examination were anterior chamber reaction and conjunctival injection seen in all the cases. Other common findings were stromal infiltration and hypopyon seen in 20(45.45%) and 18(40.91%) cases respectively. On histopathological examination the fungus was typed,as aspergillus in 34 cases while no definite typing was possible in 10 cases. The predominant isolate was aspergillus flavus(59.09%) followed by fusarium(15.91%). Mixed fungal and bacterial infection was seen in 3(6.82%) cases. ·CONCLUSION: Although culture is the gold standard for definitive diagnosis of fungal keratitis,direct microscopic examination of corneal scrapings or histomorphological evaluation of biopsies allow a rapidpreliminary diagnosis. Early administration of antifungal treatment helps in preventing dreadful complications.

Evaluation of NS1Ag and IgM antibodies against dengue,importance for epidemiological surveillance

As per the World Health Organization(WHO),a total of 100 tropical and subtropical countries are endemic for dengue, India being one of them[1].Due to the severe complications involved,non-availability of an effective preventive measure in the form of vaccination and the patient management relying largely on good supportive care,there are enough reasons explaining the importance of early