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Background: Increasing prevalence of community-acquired infections (CAIs) due to Escherichia coli and Klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBL), especially the Cefotaxime-Munich (CTX-M) type, carbapenemase, and New Delhi metallo-β-lactamase (NDM), has been reported globally posing a serious public health threat that has complicated treatment strategies for Gram-negative bacterial infections. While most of the reports in this regard are based on hospitalized patients from the urban community, there is a paucity of data in a rural community presenting with CAIs. Materials and Methods: A total of 1275 strains of E. coli and K. pneumoniae isolated over a period of 3 years from patients with CAIs were subjected to the detection of ESBL by double-disc synergy test; carbapenemase by modified Hodge test; metallo-β-lactamase by MIC test strip metallo-β-lactamase (MBL); and blaTEM, blaSHV, blaCTX-M, and blaNDMgenes by polymerase chain reaction. Results: Among 1275 E. coli and K. pneumoniae isolated during the study period, 773 (60.6%), 102 (8%), and 28 (2.2%) isolates were detected as ESBL, carbapenemase and MBL producers, respectively. Of the 773 ESBL producers, 635 (82.1%) were found to harbor blaCTX-M genes, and of the 102 carbapenemase producers, 12 (11.8%) were found to harbor blaNDMgenes. Gene sequencing of all the 12 NDM-positive isolates revealed blaNDM-1 genes. Antibiotic resistance pattern of the ESBL-positive isolates revealed a high degree of co-resistance to noncephalosporin antibiotics such as amoxyclav, co-trimoxazole, chloramphenicol, and fluoroquinolones. Conclusion: The present study showed the increasing the prevalence of ESBL including CTX-M variety, carbapenemase production by E. coli and K. pneumoniae isolates, and spread of NDM-1 in the patients from the rural community of North India. [ABSTRACT FROM AUTHOR]

Increasing faecal carriage rate of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) among livestock is responsible for abundance of these bacteria in livestock manure which is being extensively used as organic fertilizer in developing countries including India. Use of this manure can be a potential source for spread of these microorganisms to the human community, posing a serious public health threat especially, to manure handlers. There is paucity of data regarding the possible contamination of environment through use of livestock manure from rural India. Analysis of a total of 1080 manure sample pools from different segments of 40 manure heaps each year during the three years period (2015 to 2017) showed a total of 491(45.5%) E. coli and 85 (7.9%) K. pneumoniae to be detected as ESBL producers by double disc synergy test and 3 (0.6%) ESBL-EC and 3 (3.5%) ESBL-KP as carbapenemase producers by CarbaNP test. Among the ESBL producers, 436 (88.8%) ESBL-EC and 59 (69.4%) ESBL-KP were found to harbour blaCTX-M genes by PCR. The present study showed an alarmingly high prevalence of ESBL production and emerging evidence of carbapenemase production among E. coli and K. pneumoniae isolates in the manure samples from rural North India. The antibiotic resistance pattern of the ESBL producing isolates revealed high degree of co-resistance to cephalosporin and non-cephalosporin group of antibiotics. [ABSTRACT FROM AUTHOR]

Although the preventive action of dapsone against P. falciparum malaria was known for many years, there was no report about the incidence of P. falciparum malaria in leprosy patients treated with dapsone, especially from areas of Southeast Asia where both leprosy and malaria are endemic. Therefore, two clinic-based malaria surveys were undertaken at a gap of 12 years, comprising 506 lepromatous leprosy patients and 499 febrile nonleprosy control subjects. Both the surveys showed that the lepromatous patients treated with MDT had only P. vivax malaria (incidence comparable to the febrile nonleprosy controls) with complete freedom from P. falciparum. On the contrary, control sujects not taking any-leprosy drugs and staying with the leprosy patients at the same beggars' home, had both P. vivax and P. falciparum malaria. It is postulated that dapsone provided protection against P. falciparum among leprosy patients.