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   Table of Contents - Current issue
Coverpage
January-June 2018
Volume 20 | Issue 1
Page Nos. 1-59

Online since Wednesday, July 4, 2018

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ACADEMY NEWS  

Academy news p. 1
J Lancy
DOI:10.4103/jacm.jacm_15_18  
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EDITORIAL Top

Why is dengue such an important public health problem in India? p. 3
Sanjay Bhattacharya
DOI:10.4103/jacm.jacm_4_18  
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SPECIAL ARTICLE Top

Laboratory tests and clinical management of dengue in 26 healthcare institutions in India p. 5
Sanjay Bhattacharya, Gaurav Goel, Kalpana George, Ranjani Shamsundar, J Lancy, J Sudarsana, S Rema Devi, S Sangeetha, Kamla Kant, KA Sathiavathy, KL Sarada Devi, K Rejitha, TS Shailaja, Geetha Raveendran, Anu P John, T Sohanlal, George Varghese, Anitha Madhavan, Barsha Sen, KV Suseela, Syed Mustaq Ahmed, Renu Mathew, Shoba Kurian Pulikkottil, J Beena Philomina, Jily P Chinnan, Soumya Rani, Ranganathan Iyer, Sourav Maiti, Swapna R Nath, Shabina M Balakrishnan, Kavita Raja
DOI:10.4103/jacm.jacm_16_18  
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ORIGINAL ARTICLES Top

The emergence of Mupirocin resistance among the clinical isolates of Staphylococci in a rural tertiary health-care centre of South India p. 14
Vijaya Shivanna, R Nanda Kumar, D Venkatesha
DOI:10.4103/jacm.jacm_18_17  
INTRODUCTION: Mupirocin is mainly used for decolonisation of Methicillin-resistant Staphylococcus aureus among patients and health-care workers. However resistance originates from coagulase negative staphylococci (CoNS) and spreads to S. aureus by horizontal gene transfer. Hence, the present study was done to determine the overall prevalence of high- and low-level Mupirocin resistance among S. aureus and CoNS and correlate with the occurrence of Methicillin and inducible Clindamycin resistance. MATERIALS AND METHODS: A total of 100 consecutive, non-repetitive, clinical isolates of Staphylococci were obtained from various samples in a rural tertiary care hospital of Karnataka between August and September 2016. Antibiotic susceptibility testing was done according to the Clinical and Laboratory Standards Institute (M100-S25, 2015) guidelines. Low- and high-level Mupirocin resistance was screened using 5 μg and 200 μg discs, respectively. RESULTS: Of 100 staphylococcal isolates, high-level Mupirocin resistance (MupRH) was detected in 13 isolates and low-level Mupirocin resistance (MupRL) was found in 4 isolates. Of 13 HLMR isolates, majority were CoNS (12 out of 13, 92.31%). Even in LLMR isolates, 75% (3 out of 4) were CoNS. All the HLMR and LLMR isolates were Methicillin resistant (P < 0.05). CONCLUSION: High prevalence of Mupirocin resistance was found in the present study. Hence, screening for Mupirocin resistance should be routinely done and the drug must be used judiciously.
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Comparative evaluation of sensititre yeast one panel against broth microdilution method for testing Candida auris and Candida haemulonii susceptibility: A pilot study p. 19
Ramya Ramamurthi, Ananya Tupaki-Sreepurna, Anupma Jyoti Kindo
DOI:10.4103/jacm.jacm_22_17  
BACKGROUND: Candidal infection due to non-Candida albicans is on the rise and implicated to cause significant morbidity and mortality. Although empirical treatment can be provided, the sensitivity pattern varies drastically in different species of Candida. The conventional broth microdilution method for antifungal susceptibility is labour intensive. Data on antifungal susceptibility testing (AFST) by colorimetric yeast one sensititre method are available for many Candida species but not for Candida auris and Candida haemulonii. AIM: The utility of colorimetric yeast one plate was compared to conventional broth microdilution method (CLSI M27-A3 guidelines) for five isolates each of C. haemulonii and C. auris along with CLSI quality control strain Candida krusei ATCC 6258. MATERIALS AND METHODS: A total of 10 isolates of C. auris/haemulonii, confirmed by sugar assimilation and DNA sequencing were chosen. AFST was performed by conventional broth microdilution and colorimetric yeast one sensititre plates. STATISTICAL ANALYSIS: The analysis was performed by Carl Pearson's correlation coefficient. RESULTS: All isolates showed high MIC (>64 μg/mL) for Fluconazole by both methods. Strains of C. auris were found to have high MIC (>64 μg/mL) for Amphotericin B by conventional method. The degree of agreement between the two methods was 100%, 96.83% and 90.03% for Fluconazole, Posaconazole and Itraconazole, respectively, for the 10 isolates. The degree of agreement was 100%, 95.70% and 93.83% and 100%, 97.97% and 86.24% for Fluconazole, Posaconazole and Itraconazole for C. auris and C. haemulonii, respectively. CONCLUSION: AFST by colorimetric yeast one plate is less time-consuming, easy to perform and interpret, however further studies with a large number of isolates are required to test Echinocandins and Amphotericin B.
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Aetiology of acute pyogenic meningitis in children in a tertiary care hospital, Kerala p. 22
KM Rafeeda, Beena Paul, Lizy Mathew
DOI:10.4103/jacm.jacm_19_17  
INTRODUCTION: Acute bacterial meningitis is a medical emergency, and the diagnosis is by culture of cerebrospinal fluid (CSF). In this study, we looked at the changing aetiology of acute pyogenic meningitis in the context of the availability of several vaccines. MATERIALS AND METHODS: The aim of this study was to find out the aetiology and antibiotic susceptibility pattern of acute pyogenic meningitis in children between one month and 12 years in one year in a tertiary care centre. A cross-sectional study was conducted in the Department of Microbiology, Medical College Hospital, Trivandrum, in collaboration with Department of Paediatrics, SATH, Trivandrum and Christian Medical College, Vellore. CSF samples were processed by doing Gram-staining and culture in appropriate media. Latex agglutination test (LAT) and PCR were done in all cases for the primary pathogens. Blood culture and sensitivity were also done for all patients. RESULTS: Streptococcus pneumoniae (62.5%) was the most common aetiological agent for acute bacterial meningitis followed by Klebsiella pneumoniae subspp pneumoniae, Group B haemolytic Streptococci and Elizabethkingia meningosepticum. LAT could pick up one culture negative case of pneumococcal meningitis. Blood culture was positive in 37.5% of CSF culture positive cases.
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Detection of scrub typhus at a tertiary health centre in Central Kerala p. 28
Pooja Raghunath, P Jose Paul, Seema Oommen, Athulya G Asokan
DOI:10.4103/jacm.jacm_21_17  
SCOPE: Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi, transmitted by the bite of Leptotrombidium mites. It presents clinically as a non-specific febrile illness and is often overlooked. In India, there are reports of resurgence of scrub typhus. We did a cross-sectional study to detect scrub typhus among patients presenting with fever. MATERIALS AND METHODS: This study was conducted in the Department of Microbiology at a tertiary health centre in Central Kerala from January 2014 to September 2015. Two hundred and eight serum samples collected from patients presenting with fever, and whose serological tests were negative for dengue, leptospirosis, enteric fever and malaria were tested using IgM enzyme-linked immunosorbent assay (ELISA) for O. tsutsugamushi. RESULTS: Out of the 208 samples collected, 23 (11%) were positive for scrub typhus by IgM ELISA. The maximum number of cases was found in the age group of 41–60 years (56.5%). All the clinical findings were non-specific. Only one patient had an eschar. CONCLUSIONS: In the present study, we found that scrub typhus is prevalent in the districts of Central Kerala as well. Serological tests are the mainstay of diagnosis of scrub typhus and should be considered in the panel of tests ordered for patients presenting with non-specific febrile illnesses.
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Characterisation of aerobic bacteria isolated from orthopaedic implant-associated infections p. 33
Neethu Susan Philip, Ramakrishna Pai Jakribettu, Rekha Boloor, Raghuveer Adiga
DOI:10.4103/jacm.jacm_23_17  
BACKGROUND AND OBJECTIVES: Orthopaedic implant-associated infections (OAIs) are challenging to treat, as it may result in high chances of implant removal and causes huge financial burden due to absenteeism, disability, hospital stay and cost of treatment. Early detection of the infection and prompt antimicrobial therapy is very important. The study was undertaken to identify the pathogens causing OAI and their antibiogram and to formulate the antibiotic policy accordingly. METHODOLOGY: It was a prospective observational study carried out for a period of one year (January 2016 to December 2016) in the Department of Microbiology and Orthopaedics in a tertiary care centre. All patients with suspected OAI, who were admitted to the hospital, were included in the study. The pus or wound swab from these patients was tested for the pathogens and their antibiogram. RESULTS: A total of 1628 implant surgeries were conducted during the study period, of which 136 patients suspected to have OAI, amongst them 81 (59.55%) had bacterial growth. The Orthopaedic implant infection rate was 4.9%. The most common pathogen isolated was Staphylococcus aureus and of which 30.43% were methicillin-resistant strains. The most common site affected was tibia (41.97%). The majority (27.16%) of the patients had developed implant-associated infection within six months of the implant surgery. CONCLUSIONS: The OAIs it greatly affects the quality of life of the individual. Early suspicion, prompt investigation and timely treatment can reduce the morbidity caused by the OAI. Since the pathogens causing OAI can vary in hospital, the local bacterial profile of the pathogen causing OAI and their antibiogram needs to be monitored to treat the patients effectively for better outcome.
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Re-emergence of diphtheria in Malappuram district, North Kerala, India p. 37
Sheena Krishnan, Pushpa Kizhakkekarammel, Kalpana George, Jaichand Johnson, Rejitha Kurukanari, Geetha Raveendran
DOI:10.4103/jacm.jacm_2_18  
BACKGROUND AND OBJECTIVE: An outbreak of diphtheria was identified in Malappuram district, North Kerala, India, from July 2016 onwards as a sudden increase in the number of throat swabs with suspected diphtheria received in the Microbiology Lab of Government Medical College Manjeri, Malappuram district. The objective of this study was to confirm the outbreak and identify the organisms and their antibiotic sensitivity patterns. MATERIALS AND METHODS: A total of 554 throat swabs were received from July 2016 to June 2017 from neighbouring areas of Malappuram district for culture and sensitivity. Elek gel precipitation test and polymerase chain reaction of the isolates were performed at the State Public Health Lab, Thiruvananthapuram. All isolates of Corynebacterium diphtheriae possess diphtheria toxin gene. Antibiotic sensitivity tests were performed. Repeat swabs were not included in the study. RESULTS: Of the 29 (5.23%) confirmed cases, 18 (62%) were male and 11 (38%) were female. Fourteen (48.3%) cases were between 6 and 10 years of age with nine (64%) males and five (36%) females. Seven (24.2%) were between 11 and 15 years of age with four (57%) males and three (43%) females. Three (10.3%) were between 16 and 20 years of age (all males). Two (6.9%) cases from 26 to 30 years and one (3.4%) each from 21 to 25 years, 31–35 years and 36–40 years. All isolates were Penicillin sensitive. CONCLUSIONS AND DISCUSSION: Our study identified an upsurge of diphtheria in Malappuram district, North Kerala, among older children and adolescents. Most of them are partially immunised and immunity to diphtheria declines over time. Adults and adolescents thus become susceptible later in life. This emphasises the need for booster vaccination above five years in the endemic areas and making antidiphtheritic serum available in all major hospitals of these regions.
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CASE REPORTS Top

Are we missing the diagnosis of disseminated melioidosis? An unusual presentation of melioidosis with prostatic abscess p. 40
Reena Anie Jose, Vipin Sam Alexander, Anjali Anne Jacob, Renu Mathew
DOI:10.4103/jacm.jacm_30_17  
Melioidosis, an emerging infectious disease in India is well known for its protean clinical manifestations. Definitive diagnosis can be made by isolation of non-fermentative Gram-negative bacilli from clinical specimens and identification of the isolate at the species level. We report a case of disseminated melioidosis with lymphadenitis and prostatic abscess. Burkholderia pseudomallei was isolated from bone marrow, pus aspirate, blood and urine, and the patient responded well to the treatment.
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Isolation of Corynebacterium xerosis from clinical specimens: A case series p. 43
O Sasikumari, Sruthi Thomas
DOI:10.4103/jacm.jacm_68_16  
Corynebacterium xerosis is a part of the normal flora of the skin, nasopharynx, conjunctiva and vagina. There are three cases of C. xerosis isolated from various clinical specimens. All the patients were immunocompromised. The clinical condition improved after treatment with Ampicillin and Cephalexin.
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A comparative study on non-woven fabric and rigid container-based packaging system used in Central Sterile Supply Department: Experience from a cancer research centre in Eastern India p. 46
Debabrata Basu, Satyam Mukherjee, Suman Sanyal, Prokash Mondal, Gaurav Goel
DOI:10.4103/jacm.jacm_36_17  
The purpose of packaging materials used in health-care sterilisation processes is to provide a sterile barrier to protect the medical devices from outside contamination and maintaining sterility until it is used. The objective of this study is to inform the Central Sterile Supply Department technicians and infection control practitioners about the two different types of packaging system with their speciality, advantages and disadvantages so that an informed decision could be taken place before the procurement of these systems. The procurement of these systems would depend on the assessment of various factors such as material compatibility with sterilisation processes, safety features, microbial barrier efficacy, environmental impact and cost (initial investment and consumable cost).
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Case of Talaromyces marneffei skin infection in an immunocompetent adult p. 49
O Sasikumari, Thara Ann Jose, S Anupama
DOI:10.4103/jacm.jacm_66_16  
Talaromyces marneffei, earlier called Penicillium marneffei, is a fungus which causes infection mostly in immunocompromised patients. Here, we report a case of T. marneffei causing chronic skin infection in a farmer who has no history of immune deficiency. Antifungal treatment was started, but the patient expired due to complications of deep vein thrombosis.
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SHORT COMMUNICATIONS Top

Assessment of the cautionary antimicrobial consumption pattern using defined daily dose as a part of the antimicrobial Stewardship programme p. 52
Sharmin Sarosh Bala, Vinay G Pawar, Shashikala Shivaprakash
DOI:10.4103/jacm.jacm_26_17  
INTRODUCTION: Antimicrobial resistance is rapidly invading the hospital settings worldwide, threatening the ability to treat common infectious diseases. Antimicrobial Stewardship has been adopted by many institutions to enhance clinical outcomes, while diminishing the unintended consequences of antibiotics including antimicrobial resistance. METHODOLOGY: In the first phase of the Antimicrobial Stewardship Programme (ASP) conducted at a tertiary 345-bedded hospital in South Mumbai, a list of “Reserve” (cautionary) antimicrobials was prepared and circulated, followed by assessment of the utilisation pattern of the antimicrobials, awareness and training of the hospital staff, and drug utilisation review. RESULTS: Most of the cautionary antibiotics were prescribed in the geriatric population. There was a statistically significant reduction in the consumption of glycopeptides post-intervention (mean reduced by 12.58, confidence interval − 24.6, −0.47, P < 0.05). CONCLUSION: This study is the first step toward the global action plan on antimicrobial resistance adopted by the World Health Assembly.
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Limitations of the 2016 National AIDS Control Organization guidelines regarding Human Immunodeficiency Virus testing in India p. 57
Sanjay Bhattacharya, Kasturi Sengupta, Gaurav Goel
DOI:10.4103/jacm.jacm_10_17  
The current article discusses certain limitations of the 2016 National AIDS Control Organization guidelines regarding human immunodeficiency virus (HIV) testing in India. Incorporation of fourth-generation HIV antigen plus antibody tests in the screening test along with the need of immunoblot techniques (such as the western blot) for HIV confirmation would make the guidelines more robust.
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