Strongyloides stercoralis is one of the most important helminths causing neglected tropical disea... more Strongyloides stercoralis is one of the most important helminths causing neglected tropical diseases. Its ability to cause autoinfection can lead to chronic infections and hyper infection, especially in autoimmune cases and prove to be highly fatal. We report a case of systemic lupus erythematosus (SLE) having hepatitis-B coinfection, who presented with rash all over the body, recurrent nausea, vomiting, cough, loose stool, and joint pain for 1 month and was later on found to be infected with S. stercoralis. He suffered a massive cardiac arrest during his hospital stay, which was efficiently managed. S. stercoralis infection in cases of SLE and other immunocompromised conditions must be treated at the earliest, to prevent fatal cardiac arrests and other complications.
The emergence of extensively drug-resistant tuberculosis (XDR-TB) is a major concern in the India... more The emergence of extensively drug-resistant tuberculosis (XDR-TB) is a major concern in the India. The burden of XDR-TB is increasing due to inadequate monitoring, lack of proper diagnosis, and treatment. The GenoType ® Mycobacterium tuberculosis drug resistance second line (MTBDRsl) assay is a novel line probe assay used for the rapid detection of mutational patterns conferring resistance to XDR-TB. The aim of this study was to study the rapid detection of drug resistance and mutational patterns of the XDR-TB by a novel GenoType ® MTBDRsl assay. We evaluated 98 multidrug-resistant (MDR) M. tuberculosis isolates for second line drugs susceptibility testing by 1% proportion method (BacT/ALERT 3D system) and GenoType ® MTBDRsl assay for rapid detection of conferring drug resistance to XDR-TB. A total of seven (17.4%) were identified as XDR-TB by using standard phenotypic method. The concordance between phenotypic and GenoType ® MTBDRsl assay was 91.7-100% for different antibiotics. The sensitivity and specificity of the MTBDRsl assay were 100% and 100% for aminoglycosides; 100% and 100% for fluoroquinolones; 91.7% and 100% for ethambutol. The most frequent mutations and patterns were gyrA MUT1 (A90V) in seven (41.2%) and gyrA + WT1-3 + MUT1 in four (23.5%); rrs MUT1 (A1401G) in 11 (64.7%), and rrs WT1-2 + MUT1 in eight (47.1%); and embB MUT1B (M306V) in 11 (64.7%) strains. These data suggest that the GenoType ® MTBDRsl assay is rapid, novel test for detection of resistance to second line anti-tubercular drugs. This assay provides additional information about the frequency and mutational patterns responsible for XDR-TB resistance.
Study Type – Therapy (practice patterns cohort)Level of Evidence not applicableWhat's known o... more Study Type – Therapy (practice patterns cohort)Level of Evidence not applicableWhat's known on the subject? and What does the study add?Epidemiological and resistance patterns of bacterial pathogens in urinary tract infections show large inter‐regional variability, and rates of bacterial resistance are continually changing due to different regional antibiotic treatment regime. In Ireland and the UK, trimethoprim or nitrofurantoin is usually recommended for empirical treatment of uncomplicated cystitis in the community whilst parenteral cephalosporins, aminoglycosides, quinolones and co‐amoxyclav are reserved for complicated UTIs.Neither penicillins nor trimethoprim represent suitable empirical antimicrobial agents for UTI in this study population. The high rate of ciprofloxacin resistance in encountered is suggestive of an over‐reliance on this agent in this population and with resistance rates approaching 30%, empirical use of quinolones for urology patients is inadvisable. E. ...
Hypermucoviscosity is a characteristic of hypervirulent Klebsiella pneumoniae strains, which are ... more Hypermucoviscosity is a characteristic of hypervirulent Klebsiella pneumoniae strains, which are capable of causing invasive disease in community settings. This study reports phenotyping and genomic analysis of an unusual clinical isolate of Klebsiella pneumoniae , P34, which exhibits hypermucoviscosity and yet does not harbor rmp ( r egulator of m ucoid p henotype) genes, which are known determinants of hypermucoviscosity ( rmpA and rmpD ).
A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-... more A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-and-a-half years was carried out to determine the prevalence of cryptococcal infection, its associated risk factors and therapeutic outcome. Fifty-four (16.6%) patients with cryptococcal meningitis were identified by smear examination, culture and/or cryptococcal antigen latex agglutination test. Records of 45 cryptococcal meningitis patients were available; 18 (40%) of them were apparently healthy immunocompetent individuals, 13 (28.9%) had human immunodeficiency virus (HIV) infection, 9 (20%) were renal transplant recipients, 4 (8.9%) were diabetic and 1 (2.2%) had systemic lupus erythematosus. Ten (22.2%) patients died and 11 (24.4%) patients (all HIV-positive) left against medical advice. The present study indicates that cryptococcal infection is associated with high mortality. Presenting symptoms being indistinguishable from other causes of central nervous system infection, all pati...
Background: Infections caused by Nocardia spp. can occur in immunocompromised as well as immunoco... more Background: Infections caused by Nocardia spp. can occur in immunocompromised as well as immunocompetent individuals. Although nocardiosis is rare, it is being increasingly recognized owing to the rise in occurrence rate over the years. The documentation of pleural involvement in nocardiosis is rare in India, especially in the northwestern region. Here, we report a case of pleural nocardiosis in an immunocompromised patient. Case: We report a case of pulmonary nocardiosis in an immunocompromised individual caused by Nocardia otitidiscaviarum. Discussion: Pulmonary nocardiosis caused by Nocardia otitidiscaviarum may go unnoticed without clinical suspicion. Correct and timely identification is the key to proper patient management. Conclusion: Coordination between clinicians and microbiologists is necessary for early diagnosis and appropriate management of nocardiosis.
Background & objectives: Accurate diagnosis of tuberculosis (TB) is crucial to facilitate early t... more Background & objectives: Accurate diagnosis of tuberculosis (TB) is crucial to facilitate early treatment of the patients, and to reduce its spread. Clinical presentation of Mycobacterium tuberculosis complex (MTBC) and non tuberculous mycobacteria (NTM) may or may not be the same, but the treatment regimen is always different for both the infections. Differentiation between MTBC and NTM by routine laboratory methods is time consuming and cumbersome. This study was aimed to evaluate an immunochromatographic test (ICT), based on mouse monoclonal anti-MPT64, for simple and rapid discrimination between MTBC and NTM in clinical isolates from extra-pulmonary tuberculosis cases. Methods: A total of 800 clinical samples were collected from patients suspected to have extra-pulmonary tuberculosis. Preliminary diagnosis has been done by direct Ziehl-Neelsen (ZN) staining followed by culture in BACTEC system. A total of 150 clinical isolates, which were found positive in BD 460 TB system during September 2009 to September 2010 were selected for the screening by ICT test. p-nitro-α-acetylamino- β-hydroxy propiophenone (NAP) test was performed for differentiation of MTBC and NTM. M. tuberculosis complex was further confirmed by IS6110 PCR of BACTEC culture positive isolates, this served as the reference method for MTBC identification and comparative evaluation of the ICT kit. Results: Of the 150 BACTEC culture positive isolates tested by ICT kit, 101 (67.3%) were found positive for MTBC and remaining 49 (32.7%) were considered as NTM. These results were further confirmed by IS6110 PCR that served as the reference method for detection of MTBC. H 37 Rv reference strain was taken as a control for ICT test and IS6110 PCR. The reference strain showed the presence of MPT64 antigen band in the ICT test. Similar bands were formed in 101 of 102 MTBC isolates tested, proving 99.1 per cent sensitivity and no bands were detected in 48 (100%) NTM isolates tested, proving 100 per cent specificity of the ICT kit. Interpretation & conclusions: Our findings show that ICT test can be used on direct culture positive specimens. It does not require any special equipment, is simple and less time consuming. It can easily discriminate between MTBC and NTM and thus can help in appropriate management of tuberculosis.
... EXTENSIVELY DRUG RESISTANCE TUBERCULOSISNEW GENERATION OF DRUG RESISTANCE Anand Kumar Maurya... more ... EXTENSIVELY DRUG RESISTANCE TUBERCULOSISNEW GENERATION OF DRUG RESISTANCE Anand Kumar Maurya1, Surya Kant1, Ram Awadh Singh Kushwaha1 ,Vijaya ... [11] Thomas A, Ramachandran R, Rehaman F, Jaggarajamma K, Santha T, Selvakumar N, et al. ...
Transactions of The Royal Society of Tropical Medicine and Hygiene, Apr 14, 2020
Background Crimean Congo haemorrhagic fever (CCHF) is an emerging zoonotic infection with high mo... more Background Crimean Congo haemorrhagic fever (CCHF) is an emerging zoonotic infection with high mortality. Nosocomial spread is described secondary to body fluid contact. Methods Patients meeting the case definition for viral haemorrhagic fever (VHF) from August to November 2019 were tested for CCHF after ruling out dengue, malaria, scrub typhus and leptospirosis in a tertiary teaching hospital in western Rajasthan, India. Diagnosis was confirmed using both quantitative reverse transcription polymerase chain reaction and immunoglobulin M/immunoglobulin G enzyme-linked immunosorbent assay for all patients. All hospital contacts were line listed and tested and symptomatic high-risk contacts received ribavirin post-exposure prophylaxis. Cohorting, personal protective equipment use and hand washing were employed to prevent nosocomial spread. Results Four patients tested positive for CCHF. We encountered uncommon initial presentations involving motor weakness and supraventricular tachycardia. Elevated serum lactate dehydrogenase and creatinine kinase were useful in clinical diagnosis. Only one patient survived despite ribavirin therapy. There was zero nosocomial transmission. A partial segment of nucleocapsid of amplified CCHF virus was 99.62% identical to the Afghanistan and Oman strains. Conclusions The distribution of CCHF appears to be expanding, with CCHF emerging as endemic in Rajasthan, India. In this setting of high mortality, hand washing and PPE use prevented nosocomial transmission.
Biomedical and biotechnology research journal, 2017
Nontuberculous mycobacteria (NTM) infections are ever more important in recent years for leading ... more Nontuberculous mycobacteria (NTM) infections are ever more important in recent years for leading causes of morbidity and mortality worldwide. Clinical appearance of Mycobacterium tuberculosis (TB) complex and NTM is same, but the treatment regimen is always different. NTM is challenging for both diagnostic and therapeutic with reason that it mimic pathological, microbiological, immunological, and radiological findings of TB. Newer molecular diagnostic methods allow for a better identification of NTM infections in patients not responding to antitubercular treatment and falsely categorized as drug-resistant TB. This article will explore the recent methods for the diagnosis and identification of NTM infections in clinical practice. In the future, the molecular-based diagnosis will significantly reduce the turnaround time of the diagnosis and thereby improving patient outcome.
Strongyloides stercoralis is one of the most important helminths causing neglected tropical disea... more Strongyloides stercoralis is one of the most important helminths causing neglected tropical diseases. Its ability to cause autoinfection can lead to chronic infections and hyper infection, especially in autoimmune cases and prove to be highly fatal. We report a case of systemic lupus erythematosus (SLE) having hepatitis-B coinfection, who presented with rash all over the body, recurrent nausea, vomiting, cough, loose stool, and joint pain for 1 month and was later on found to be infected with S. stercoralis. He suffered a massive cardiac arrest during his hospital stay, which was efficiently managed. S. stercoralis infection in cases of SLE and other immunocompromised conditions must be treated at the earliest, to prevent fatal cardiac arrests and other complications.
The emergence of extensively drug-resistant tuberculosis (XDR-TB) is a major concern in the India... more The emergence of extensively drug-resistant tuberculosis (XDR-TB) is a major concern in the India. The burden of XDR-TB is increasing due to inadequate monitoring, lack of proper diagnosis, and treatment. The GenoType ® Mycobacterium tuberculosis drug resistance second line (MTBDRsl) assay is a novel line probe assay used for the rapid detection of mutational patterns conferring resistance to XDR-TB. The aim of this study was to study the rapid detection of drug resistance and mutational patterns of the XDR-TB by a novel GenoType ® MTBDRsl assay. We evaluated 98 multidrug-resistant (MDR) M. tuberculosis isolates for second line drugs susceptibility testing by 1% proportion method (BacT/ALERT 3D system) and GenoType ® MTBDRsl assay for rapid detection of conferring drug resistance to XDR-TB. A total of seven (17.4%) were identified as XDR-TB by using standard phenotypic method. The concordance between phenotypic and GenoType ® MTBDRsl assay was 91.7-100% for different antibiotics. The sensitivity and specificity of the MTBDRsl assay were 100% and 100% for aminoglycosides; 100% and 100% for fluoroquinolones; 91.7% and 100% for ethambutol. The most frequent mutations and patterns were gyrA MUT1 (A90V) in seven (41.2%) and gyrA + WT1-3 + MUT1 in four (23.5%); rrs MUT1 (A1401G) in 11 (64.7%), and rrs WT1-2 + MUT1 in eight (47.1%); and embB MUT1B (M306V) in 11 (64.7%) strains. These data suggest that the GenoType ® MTBDRsl assay is rapid, novel test for detection of resistance to second line anti-tubercular drugs. This assay provides additional information about the frequency and mutational patterns responsible for XDR-TB resistance.
Study Type – Therapy (practice patterns cohort)Level of Evidence not applicableWhat's known o... more Study Type – Therapy (practice patterns cohort)Level of Evidence not applicableWhat's known on the subject? and What does the study add?Epidemiological and resistance patterns of bacterial pathogens in urinary tract infections show large inter‐regional variability, and rates of bacterial resistance are continually changing due to different regional antibiotic treatment regime. In Ireland and the UK, trimethoprim or nitrofurantoin is usually recommended for empirical treatment of uncomplicated cystitis in the community whilst parenteral cephalosporins, aminoglycosides, quinolones and co‐amoxyclav are reserved for complicated UTIs.Neither penicillins nor trimethoprim represent suitable empirical antimicrobial agents for UTI in this study population. The high rate of ciprofloxacin resistance in encountered is suggestive of an over‐reliance on this agent in this population and with resistance rates approaching 30%, empirical use of quinolones for urology patients is inadvisable. E. ...
Hypermucoviscosity is a characteristic of hypervirulent Klebsiella pneumoniae strains, which are ... more Hypermucoviscosity is a characteristic of hypervirulent Klebsiella pneumoniae strains, which are capable of causing invasive disease in community settings. This study reports phenotyping and genomic analysis of an unusual clinical isolate of Klebsiella pneumoniae , P34, which exhibits hypermucoviscosity and yet does not harbor rmp ( r egulator of m ucoid p henotype) genes, which are known determinants of hypermucoviscosity ( rmpA and rmpD ).
A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-... more A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-and-a-half years was carried out to determine the prevalence of cryptococcal infection, its associated risk factors and therapeutic outcome. Fifty-four (16.6%) patients with cryptococcal meningitis were identified by smear examination, culture and/or cryptococcal antigen latex agglutination test. Records of 45 cryptococcal meningitis patients were available; 18 (40%) of them were apparently healthy immunocompetent individuals, 13 (28.9%) had human immunodeficiency virus (HIV) infection, 9 (20%) were renal transplant recipients, 4 (8.9%) were diabetic and 1 (2.2%) had systemic lupus erythematosus. Ten (22.2%) patients died and 11 (24.4%) patients (all HIV-positive) left against medical advice. The present study indicates that cryptococcal infection is associated with high mortality. Presenting symptoms being indistinguishable from other causes of central nervous system infection, all pati...
Background: Infections caused by Nocardia spp. can occur in immunocompromised as well as immunoco... more Background: Infections caused by Nocardia spp. can occur in immunocompromised as well as immunocompetent individuals. Although nocardiosis is rare, it is being increasingly recognized owing to the rise in occurrence rate over the years. The documentation of pleural involvement in nocardiosis is rare in India, especially in the northwestern region. Here, we report a case of pleural nocardiosis in an immunocompromised patient. Case: We report a case of pulmonary nocardiosis in an immunocompromised individual caused by Nocardia otitidiscaviarum. Discussion: Pulmonary nocardiosis caused by Nocardia otitidiscaviarum may go unnoticed without clinical suspicion. Correct and timely identification is the key to proper patient management. Conclusion: Coordination between clinicians and microbiologists is necessary for early diagnosis and appropriate management of nocardiosis.
Background & objectives: Accurate diagnosis of tuberculosis (TB) is crucial to facilitate early t... more Background & objectives: Accurate diagnosis of tuberculosis (TB) is crucial to facilitate early treatment of the patients, and to reduce its spread. Clinical presentation of Mycobacterium tuberculosis complex (MTBC) and non tuberculous mycobacteria (NTM) may or may not be the same, but the treatment regimen is always different for both the infections. Differentiation between MTBC and NTM by routine laboratory methods is time consuming and cumbersome. This study was aimed to evaluate an immunochromatographic test (ICT), based on mouse monoclonal anti-MPT64, for simple and rapid discrimination between MTBC and NTM in clinical isolates from extra-pulmonary tuberculosis cases. Methods: A total of 800 clinical samples were collected from patients suspected to have extra-pulmonary tuberculosis. Preliminary diagnosis has been done by direct Ziehl-Neelsen (ZN) staining followed by culture in BACTEC system. A total of 150 clinical isolates, which were found positive in BD 460 TB system during September 2009 to September 2010 were selected for the screening by ICT test. p-nitro-α-acetylamino- β-hydroxy propiophenone (NAP) test was performed for differentiation of MTBC and NTM. M. tuberculosis complex was further confirmed by IS6110 PCR of BACTEC culture positive isolates, this served as the reference method for MTBC identification and comparative evaluation of the ICT kit. Results: Of the 150 BACTEC culture positive isolates tested by ICT kit, 101 (67.3%) were found positive for MTBC and remaining 49 (32.7%) were considered as NTM. These results were further confirmed by IS6110 PCR that served as the reference method for detection of MTBC. H 37 Rv reference strain was taken as a control for ICT test and IS6110 PCR. The reference strain showed the presence of MPT64 antigen band in the ICT test. Similar bands were formed in 101 of 102 MTBC isolates tested, proving 99.1 per cent sensitivity and no bands were detected in 48 (100%) NTM isolates tested, proving 100 per cent specificity of the ICT kit. Interpretation & conclusions: Our findings show that ICT test can be used on direct culture positive specimens. It does not require any special equipment, is simple and less time consuming. It can easily discriminate between MTBC and NTM and thus can help in appropriate management of tuberculosis.
... EXTENSIVELY DRUG RESISTANCE TUBERCULOSISNEW GENERATION OF DRUG RESISTANCE Anand Kumar Maurya... more ... EXTENSIVELY DRUG RESISTANCE TUBERCULOSISNEW GENERATION OF DRUG RESISTANCE Anand Kumar Maurya1, Surya Kant1, Ram Awadh Singh Kushwaha1 ,Vijaya ... [11] Thomas A, Ramachandran R, Rehaman F, Jaggarajamma K, Santha T, Selvakumar N, et al. ...
Transactions of The Royal Society of Tropical Medicine and Hygiene, Apr 14, 2020
Background Crimean Congo haemorrhagic fever (CCHF) is an emerging zoonotic infection with high mo... more Background Crimean Congo haemorrhagic fever (CCHF) is an emerging zoonotic infection with high mortality. Nosocomial spread is described secondary to body fluid contact. Methods Patients meeting the case definition for viral haemorrhagic fever (VHF) from August to November 2019 were tested for CCHF after ruling out dengue, malaria, scrub typhus and leptospirosis in a tertiary teaching hospital in western Rajasthan, India. Diagnosis was confirmed using both quantitative reverse transcription polymerase chain reaction and immunoglobulin M/immunoglobulin G enzyme-linked immunosorbent assay for all patients. All hospital contacts were line listed and tested and symptomatic high-risk contacts received ribavirin post-exposure prophylaxis. Cohorting, personal protective equipment use and hand washing were employed to prevent nosocomial spread. Results Four patients tested positive for CCHF. We encountered uncommon initial presentations involving motor weakness and supraventricular tachycardia. Elevated serum lactate dehydrogenase and creatinine kinase were useful in clinical diagnosis. Only one patient survived despite ribavirin therapy. There was zero nosocomial transmission. A partial segment of nucleocapsid of amplified CCHF virus was 99.62% identical to the Afghanistan and Oman strains. Conclusions The distribution of CCHF appears to be expanding, with CCHF emerging as endemic in Rajasthan, India. In this setting of high mortality, hand washing and PPE use prevented nosocomial transmission.
Biomedical and biotechnology research journal, 2017
Nontuberculous mycobacteria (NTM) infections are ever more important in recent years for leading ... more Nontuberculous mycobacteria (NTM) infections are ever more important in recent years for leading causes of morbidity and mortality worldwide. Clinical appearance of Mycobacterium tuberculosis (TB) complex and NTM is same, but the treatment regimen is always different. NTM is challenging for both diagnostic and therapeutic with reason that it mimic pathological, microbiological, immunological, and radiological findings of TB. Newer molecular diagnostic methods allow for a better identification of NTM infections in patients not responding to antitubercular treatment and falsely categorized as drug-resistant TB. This article will explore the recent methods for the diagnosis and identification of NTM infections in clinical practice. In the future, the molecular-based diagnosis will significantly reduce the turnaround time of the diagnosis and thereby improving patient outcome.
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