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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 21 | Issue 2
Page Nos. 59-109

Online since Friday, January 17, 2020

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ACADEMY NEWS  

Academy news p. 59
Manjusree Shanmugham
DOI:10.4103/jacm.jacm_37  
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REVIEW ARTICLE Top

Clinical and cost-effectiveness of antimicrobial stewardship programmes p. 60
Pooja Shivananda Siddhi, Mitul Patel
DOI:10.4103/jacm.jacm_7_19  
Antimicrobial resistance is on an increasing trend worldwide. The WHO has declared it to be a 'Global Threat' in the year 2015. Due to this growing concern, antimicrobial stewardship (AMS) programmes have been implemented all over the world in the last few decades. The main challenge in AMS programme is the long-term sustenance, and hence, there is no worldwide agreed consensus on the 'best' AMS strategies. This review article provides an overview of the evolution of AMS strategies through the years and highlights the clinical effectiveness and cost-effectiveness of the strategies implemented till date.
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MINI REVIEW Top

Advantages and limitations of rapid biological indicator for fast sterilisation assurance p. 66
Debabrata Basu, Subhas Chandra Bag, Satyam Mukherjee, Gaurav Goel
DOI:10.4103/jacm.jacm_20_18  
Continuous quality monitoring in sterilisation processes is paramount importance for supplying sterile materials to the patients. The sterilisation monitoring is required because early prediction of steriliser malfunctioning is impossible, and malfunction gets detected only when it runs. Internationally there are three types of sterilisation monitoring system such as physical, chemical and biological monitoring. The physical monitoring system is dependent on time, temperature and pressure. The chemical and biological monitoring systems are also dependent on the same physical parameters but in addition require the presence of condensing steam for sterility assurance. The main aim of this article is to elaborate differences between the 'conventional biological indicator' and the 'rapid biological indicator' with their benefits and disadvantages for biologically proven sterility assurances. However, it is not possible to determine whether biological material in the indicator is alive or dead, visually. The article explains that the detection of living spores can be technically challenging, and each and every step should be monitored carefully because spores are highly resistant to harsh environmental conditions. The results show that proper incubation time in an appropriate growth medium and optimal temperature is the only way to detect the living microorganisms in a biological indicator for proper sterility assurance.
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ORIGINAL ARTICLES Top

Bacteriological profile and antimicrobial susceptibility pattern of non-lactational breast abscess p. 70
Bimoch Projna Paty, Sasmita Hotta, Abhishek Padhi, Sanghamitra Padhi, Banojini Parida
DOI:10.4103/jacm.jacm_14_18  
BACKGROUND: Breast abscess is a common condition among OPD female patients. It has been reported that 4.6 % and 11% of the women in developed and developing countries are affected by breast abscess. AIMS AND OBJECTIVES: To detect the pathogens causing non lactational breast abscess and to determine their antibiotic sensitivity pattern. MATERIALS AND METHODS: 50 pus samples with diagnosis of non lactational breast abscess were obtained by incision and drainage or by aspiration. Specimens were processed for Gram stain and cultured in both aerobic and anaerobic media. For aerobic blood agar (BA) and Mac-Conkey agar were inoculated. For anaerobic isolation Brucella blood agar (BBA) with 5% sheep blood agar, hemin and vit-k were inoculated and Metronidazole disc was placed in primary streaking line. Plates were incubated in Mark-II Anaerobic system. Isolates were identified by Gram stain, biochemical tests and sensitivities to identification discs like Vancomycin, Kanamycin, Colistin and SPS. Sensitivity patterns of the aerobic isolates were determined by Kirby-Bauer disc diffusion method. RESULTS: Maximum no of cases belongs to age group of 36-45 years (42%). Out of the 50 pus samples 36(72%) were found to be culture positive from which 42 number of bacteria were isolated. Aerobes and facultative anaerobes predominated 30(71%) over the anaerobes 12 (29%). Staphylococcus aureus 11(36%) was found to be the predominant organism. Clostridium perfringens 6(50%) was the commonest anaerobe isolated. Gram positive isolates were sensitive to Clindamycin, Linezolid and Vancomycin and gram negative bacteria were sensitive to Imipenem and Piperacillin-Tazobactam. Percentage of MRSA was 43% .Amongst the gram negative bacteria ESBL production was seen in 55% of isolates. CONCLUSION: Breast abscess is a fairly common surgical problem among both lactational and non-lactational females. Besides aerobes non-lactating breast abscesses also showed the presence of anaerobic bacteria. As minimally invasive management of breast abscesses, such as ultrasound guided drainage with systemic antibiotic drug therapy is the treatment of choice it is essential to provide the appropriate empirical antibiotic therapy in this drug resistance era.
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Does pre-lecture Whatsapp intervention; enhance the knowledge of medical students in Clinical Microbiology? p. 74
Ragini Ananth Kashid
DOI:10.4103/jacm.jacm_9_19  
INTRODUCTION: The most common method used to teach Clinical Microbiology is lecture. Lectures may not be interactive and interesting. Hence, the facilitator has to adopt newer teaching methods. WhatsApp is an interactive and interesting method to enhance medical education. Therefore, we decided to evaluate the effect of WhatsApp teaching, on the knowledge gain, in medical students. OBJECTIVE: To assess the knowledge gain, in medical students, using WhatsApp for teaching. METHODOLOGY: With institutional ethical committee approval taken, 146 medical students, who had smartphones and were using WhatsApp, were included in this study. By simple random sampling, an interventional study was conducted, by dividing them into two groups. The students in the intervention group (n = 73) were primed through WhatsApp, before the lecture session. The students in the control group (n = 73) attended the lecture, without prior exposure to the WhatsApp session. Ten pre- and post-lecture multiple-choice questions were given to both the groups. For the next lecture, crossover of the groups was done. RESULTS: 71.23% and 76.71% of the students in Group A and Group B, respectively, participated in the WhatsApp group discussion. In Session 1, the median score of pre-test of Batch A (intervention group) was 5 and Batch B (control group) was 4. The median score of post-test of both Batch A and Batch B was 7. In Session 2, the median score of pretest of Batch A (control group) was 4 and Batch B (intervention group) was 5. The median score of post-test of both Batch A and Batch B was 9. DISCUSSION: The percentage increase in knowledge, after the lecture, was statistically significant (P < 0.001). It is similar in both the Groups (A and B), in both the Sessions (1 and 2). This means that the control group (unexposed to the WhatsApp intervention) has also done well in the post-test. This is attributed to the lecture and not to the WhatsApp intervention. CONCLUSION: Although WhatsApp has several technical advantages, it has not contributed to the knowledge gain in the medical students.
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Seroprevalence of hepatitis E in healthy adults attending a tertiary care centre in Central Kerala p. 80
KG Chithira, Reena John, Prithi Nair
DOI:10.4103/jacm.jacm_33_19  
BACKGROUND: Hepatitis E virus (HEV) is emerging globally as a leading cause of an acute and generally self-limited hepatitis but is associated with a higher mortality, especially during pregnancy. AIM: The purpose of this study was to estimate the seroprevalence of hepatitis E infection among adults with no previous history of jaundice/liver disease, in a tertiary care centre at Thrissur. STUDY SETTING AND DESIGN: Hospital based cross sectional study was carried out in Government Medical College, Thrissur. MATERIALS AND METHODS: Anti-HEV IgG was detected by using commercially available enzyme linked immunosorbent assay. RESULT: The seroprevalence of HEV among blood donors and antenatal was approximately 1.2%. CONCLUSION: HEV is less prevalent in this region. The low seropositivity among healthy adults shows an increased susceptibility to HEV infection. Since there is an increase in migrantsfrom high endemic area, screening for HEV in adult population especially pregnant females is desirable.
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CASE REPORTS Top

First report of intracranial epidermoid cyst infection and brain abscess caused by Salmonella Paratyphi A p. 85
Dinoop Korol Ponnambath, Patel Biren Khimji, Jyothi Embekkat Kaviyil, Kavita Raja, George C Vilanilam, Bejoy Thomas
DOI:10.4103/jacm.jacm_31_19  
We report the first case of brain abscess caused by Salmonella Paratyphi A in a young immunocompetent boy with an intracranial epidermoid cyst. A 10-year-old boy presented with gradual onset of headache, progressively increasing over one month duration. The patient was diagnosed with a benign intracranial epidermoid cyst involving the left anterior cranial fossa insinuating to left medial frontal lobe due the initial presentation, and repeat magnetic resonance Imaging taken after two weeks during to worsening of headache revealed pyogenic infection of the epidermoid cyst. The drained pus showed plenty of polymorphonuclear cells with thin Gram-negative bacilli on Gram staining and culture revealed the growth of S. Paratyphi A, which was confirmed by VITEK 2 compact system and serotyping. The isolate was susceptible to Ampicillin, Cotrimoxazole, Ciprofloxacin, Ceftriaxone and Tetracycline. The patient was successfully managed initially with empirical intravenous Meropenem for two weeks and then deescalated to oral Cefixime and Ciprofloxacin. There were no focal neurological deficits while the patient was discharged with advice on antibiotic continuation for two weeks.
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Post-operative infective endocarditis with aortic root abscess due to Mycobacterium abscessus p. 89
Heera Hassan, Dinoop Korol Ponnambath, Kavita Raja
DOI:10.4103/jacm.jacm_28_19  
Aortic root abscess is a complication of native and prosthetic valve infective endocarditis with a higher risk for prosthetic valves. The patients with aortic root abscess may present with symptoms ranging from pyrexia of unknown origin to arrhythmia. The usual aetiological agents are Staphylococcus aureus, alpha-lytic Streptococci and other skin flora. Here, we present a case report of aortic root abscess in a patient with a history of aortic valve repair. The aetiological agent was identified as Mycobacterium abscessus. This is probably the first case report of aortic root abscess with M. abscessus. The patients responded to empiric antibiotics without surgery.
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Mycotic aneurysm by non-typhoidal Salmonella p. 94
Jyothi Embekkat Kaviyil, Shivanesan Pitchai, Dinoop Korol Ponnambath, Kavita Raja
DOI:10.4103/jacm.jacm_27_19  
Mycotic aneurysm is an arterial dilatation due to vessel damage caused by an infection. It encompasses primary infection of native artery resulting in aneurysm as well as an infection of pre-existing aneurysm. Mycotic aneurysm is a rare complication of salmonellosis and can be fatal if not diagnosed and treated at early stages. Here, we describe a rare case of abdominal aortic aneurysm caused by non- typhoidal Salmonella (Salmonella Enteritidis/Salmonella enterica serotype Enteritidis) which was successfully managed by a combination of surgical intervention and antibiotic therapy.
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Cryptococcal meningitis presenting as sixth nerve palsy p. 97
Meghana Venunath, Anitha Madhavan, B Sobha
DOI:10.4103/jacm.jacm_10_19  
Clinical features of cryptococcal meningitis can often be non-specific in immunocompetent without neurological deficit. We present a case of a middle-aged female with no known co-morbidities who presented with sub-acute onset of occipital headache, vomiting and isolated 6th nerve palsy, photophobia and double vision of 2 weeks. It progressed with development of multiple nerve palsies, bilateral lower limb paresis and complete loss of vision. She had no evidence of immunosuppression.
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SHORT COMMUNICATION Top

Low incidence and the prevalence of brucellosis among patients with pyrexia of unknown origin based on real-time polymerase chain reaction, enzyme-linked immunosorbent assay and standard agglutination test results in Puducherry, South India p. 100
Udhayasankar Ranganathan, M Maanasa Bhaskar, Harish Belgode Narasimha
DOI:10.4103/jacm.jacm_15_19  
CONTEXT: Brucellosis is a zoonotic disease and an important differential to be considered in patients with pyrexia of unknown origin (PUO). The laboratory diagnosis of brucellosis has always been affected by various factors such as the slow growth of the organism and cross-reacting antibodies. Hence, a diagnostic test with high sensitivity and specificity is the key for the accurate and rapid diagnosis. AIM: The study aimed to evaluate the role of real-time polymerase chain reaction (PCR) in the rapid diagnosis of human brucellosis from direct serum samples of patients with PUO. MATERIALS AND METHODS: An observational study was conducted from October 2014 to September 2016 at a tertiary care hospital in Puducherry where 138 blood samples were obtained from the patients with PUO. Serum separated from each sample was tested for brucellosis using Cobas 480 Z real-time PCR system. Simultaneously, the samples were also subject to blood culture, standard agglutination test (SAT) and enzyme-linked immunosorbent assay (ELISA) (IgG and IgM) for brucellosis. RESULTS: All the samples were found to be negative for brucellosis using real-time PCR. Blood culture also did not yield any growth of Brucella spp. Among the serological tests, all the samples were negative by SAT, whereas two were positive for IgM and four for IgG anti-Brucella antibodies using ELISA. CONCLUSION: Brucellosis is not a common cause of PUO among patients attending this hospital since all the samples were negative by highly sensitive and specific tests such as real-time PCR and blood culture. This study highlights the limitations of serological tests such as ELISA in the accurate diagnosis of brucellosis.
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QUESTIONNAIRE FOR SPECIAL ARTICLE Top

Questionnaire for special article on Mycology Diagnostics and Antifungal Stewardship p. 104
Gaurav Goel
DOI:10.4103/jacm.jacm_36_19  
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