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BACKGROUND: Female genital tuberculosis often faces diagnostic challenges due to the asymptomatic nature of the disease. Our study aims at comparing the microbiological and histopathological results with PCR in diagnosing genital tuberculosis in endometrial curettage specimens. METHODS: Around 139 patients with diverse gynaecological complaints were recruited for the study, and endometrial curettage specimens were collected. The specimens were subjected to microbiological culture and staining, histopathological examination and PCR to look for the presence of M. tuberculosis. Statistical analyses of the PCR results include calculating sensitivity, specificity, positive and negative prediction values and positive and negative likelihood ratios. RESULTS: PCR yielded a detection rate of 41.7% (58/139) when compared to the microbiology (2.15%) and histopathology results (1.43%). PCR with hsp65 and cfp10, in combination, detected 20% of the cases. Statistical analyses were suggestive that PCR with hsp65 showed a higher sensitivity and specificity of 50% and 92.59% respectively. CONCLUSION: The results obtained in this study suggest that for a definitive diagnosis, combinations of the results from various diagnostics techniques can only be considered.

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. There are reports of resurgence of scrub typhus in different parts of India including Kerala. Many cases go undiagnosed due to the lack of knowledge regarding the diagnostic test to be used. This study was undertaken at Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla in the Department of Microbiology from January 2014 to September 2015, to assess the validity of various tests in diagnosing scrub typhus. A total of 94 samples were subjected to IgM ELISA, Weil Felix (WF) test and Indirect Immunouorescence assay(IFA). The agreement between ELISA, IFA and Weil Felix test was assessed by κ (kappa) coefcient of Cohen using SPSS version 17. The sensitivity and specicity of ELISA with respect to IFA was 100% and 94.67% respectively, and that of IFA with respect to ELISA was 82.61% and 100% respectively. The sensitivity and specicity of WF test with respect to ELISA was 43.48 and 100% respectively and that of WF test with respect to IFA was 52.63% and 100% respectively. Although IgM ELISA is highly sensitive, it cannot be relied upon as the sole diagnostic test due to high false positivity. WF test is not a sensitive test, but when positive it is rather specic. IFA has high sensitivity and specicity, but is unsuitable for moderately equipped laboratories. Hence, we suggest that scrub typhus could be diagnosed using a combination of IgM ELISA and WF test and these tests should be included in the panel of serological tests ordered for patients presenting with undifferentiated febrile illnesses.

Background: Hepatitis C is an emerging infection in India, which is known to progresses to liver cirrhosis and hepatocellular carcinoma. The persistence of chronic HCV infection is due to the existence of various genotypes and its various subtypes. There are seven different genotypes of HCV. These genotypes vary in their severity to cause infections as well as their response to treatment. Aim: This study aims at identifying the predominant genotypes of HCV in a population of patients presenting in a tertiary care center in Central Kerala. Settings and Design: This study was conducted at a tertiary care hospital and medical college, located in Central Kerala in the Department of Microbiology from January 2014 to June 2015.The sample size was 600 and a high risk group of patients attending the gastroenterology department, deaddiction centre and health care workers were screened. Materials and Methods: Serum samples were subjected to EIA, either rapid card or ELISA. Serum samples that were positive for HCV antibodies were confirmed by PCR. Twenty seven samples were positive for HCV antibodies by ELISA/rapid card, out of which 16 were confirmed by PCR. These 16 samples were subjected to gene sequencing to identify the genotype. Results: The prevalent genotypes isolated in this study was genotype 1, 3 and 4. Genotype 1 and 3 was predominantly seen transmitted by blood transfusions and multiple hemodialysis. The variability in laboratory parameters like SGOT and SGPT and its ratio with each genotype was also evaluated. Conclusion: To conclude, the occurrence of genotype 4 at a similar level to genotype 1 shows diffusion of new genotype in Kerala.

There have been rapid technological advances in the detection of Mycobacterium tuberculosis and its drug susceptibility in clinical samples. These include advances in microscopic examination, in vitro culture and application of molecular techniques. The World Health Organization (WHO) has played a large role in evaluating these technologies for their efficacy and feasibility, especially in the developing countries. Amongst these, the Revised National Tuberculosis Control Programme (RNTCP), through its national network of designated microscopy centres and intermediate reference laboratories, has adopted certain technologies that are currently implemented in India. Advances in microscopy technology include fluorescent microscopy using light-emitting diode source, sodium hypochlorite microscopy and vital fluorescent staining of sputum smears. Automation of in vitro culture has markedly reduced the turnaround time (TAT), even in smear-negative samples, and permits simultaneous detection of resistant mutants. Molecular detection of drug resistance has further reduced the TAT, and the cartridge-based nucleic acid amplification test with its performance convenience and rapid results, appears poised to become the future of tuberculosis (TB) diagnosis in all settings, provided the cost of testing is reduced especially for use in private diagnostic settings. This article reviews technologies currently available for the diagnosis of TB, keeping in mind the WHO recommendations and the RNTCP practices. This is a thematic synthesis of data available on diagnosis in literature, preserving the conclusions of the primary studies.

Background: The presence of antinuclear antibodies (ANA) is a hallmark of autoimmune diseases. As Clinicopathological classification of autoimmune diseases is difficult without laboratory support, laboratory testing is of helps in diagnosis, treatment, prognosis, and prediction of the pathological changes by disease activity. Although different tests are available for ANA detection enzyme linked immunosorbent assay (ELISA) is the mainstay of diagnosis in most routine laboratories. Indirect immunofluorescence antinuclear antibody test (IFA) though currently the “gold standard” it is not widely practiced. Most studies have used Hep2 cells for the detection of autoantibodies by IFA. However Hep 2000 Ro is superior compared to Hep 2 which lacks capability of detecting some autoantibodies like Ro antibodies. Hence, this study was undertaken to compare the diagnostic value and cost effectiveness of ANA pattern, ELISA with profile testing for patients suspected to have autoimmune disorders. Results: In the present study we observed high prevalence of autoimmune diseases in females (75.82%).ANA-ELISA in criteria matched cases with respect to ANA-IFA had a low sensitivity (59% versus 80%), higher specificity (84% versus 70%). Statistical analysis of ELISA and IFA with respect to ANA Profile showed a very less sensitivity by ELISA over IFA (51% vs. 78%) and equal specificity (70-72%) in 142 criteria matched cases. Conclusions: Statistically significant differences between ELISA and IFA infers IFA-ANA is a very appropriate method for screening purposes also IFA have capability of finding anti-mitochondrial and other cytoplasmic antibodies, which is not possible with ELISA.

INTRODUCTION: Clostridioides difficile infection (CDI) is one of the hospital-acquired infections and the most common cause for antibiotic-associated diarrhoea. Documentation of CDI is difficult, and interpretation of diagnostic results often requires consultation with clinical microbiologists. The purpose of this study was to compare the results of the combination of glutamate dehydrogenase enzyme (GDH) and toxin assay with the polymerase chain reaction (PCR) results, in order to find if the combination could substitute for the expensive molecular tests. MATERIALS AND METHODS: The sample size was statistically calculated to be 30, using an SPSS software. Both GDH and toxin assay were simultaneously tested in all the randomly selected stool samples, by simple random sampling, and irrespective of the results, they were also tested for tcdB gene by PCR in the present study. All the samples were also plated onto Brazier's C. difficile agar and incubated anaerobically. RESULTS: The sensitivity and specificity of GDH (using PCR as gold standard) were found to be 100% and 76.47%, respectively, and the sensitivity and specificity of toxin enzyme immunoassay (EIA) assay (using PCR as gold standard) were found to be 66.67% and 92.86%, respectively. However, when the toxin-equivocal results were also considered as positive, the sensitivity of toxin EIA was found to be 100%. The overall agreeability, using Cohen's Kappa statistic between GDH and toxin detection by enzyme-linked fluorescence assay, showed that they had moderate and substantial agreement, respectively, when compared to PCR. CONCLUSIONS: In this study, each of the toxin negatives and positives was also PCR negative and positive, respectively. All the toxin-equivocal samples tested positive on PCR, so it is our conclusion that in the settings where they cannot be taken for further molecular testing, those samples be considered as harbouring toxigenic C. difficile.

Hepatocellular carcinoma (HCC) is one of the most prevalent cancers which are found in many Asian and African countries. There are several risk factors that may develop to HCC. Along with several other factors contributing to HCC, hepatitis B virus (HBV) infection also accounts for a major cause. HBV infection represents a major health problem worldwide. Among all of HBV genes, HBx is believed to play a prominent role in carcinogenesis, although the actual mechanism is not yet fully understood. The HBx gene of HBV is the most common open reading frame that may undergo mutations and may develop into HCC. This review summarizes the current knowledge about the most important roles of HBx gene that may lead to the development of HCC.

Since the identity of the respiratory pathogen is not known at the time of admission, emergency department personnel and intensive care staff are at the highest risk of exposure while handling such patients.

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.

Diarrhoea and dysentery caused by Shigella spp. are major public health concerns. Emerging multidrug resistance (MDR) in this pathogen further complicates this disease. Extended spectrum β-lactamases (ESBLs) have been described in this pathogen, which significantly compromises the treatment options for shigellosis. The usual ESBLs seen are sulfhydryl variable (SHV)-type; cefotaximases (CTX-M) are very uncommonly detected. Here, we report a CTX-M type and AmpC-producing Shigella flexneri from a three-year-old boy residing in Central Kerala, South India.

Brain abscess is an uncommon and serious life-threatening infection in children. Focal intracranial infections caused by Salmonella spp. in this age group are also rare. We report the case of a 4-month-old male infant with a frontoparietal brain abscess caused by Salmonella typhimurium, the presence of which was not suspected clinically.

Introduction : Non-Typhoidal Salmonella (NTS) species are important food borne pathogens with acute gastroenteritis being the most common clinical manifestation. Certain serovars of Salmonella show a much higher predilection for causing bacteraemia. Though NTS infections are associated with significant morbidity and mortality worldwide; data on NTS in India are limited. Objectives : The aim of this study was to describe the prevalence and epidemiology of Non-Typhoidal Salmonella (NTS) in central Kerala, and to compare their sensitivity patterns with typhoidal Salmonella. Methods : A retrospective study was done on the blood and stool culture samples received by the microbiology laboratory of a tertiary care centre from January 2012 to August 2014. NTS were isolated and identified using standard bacteriological methods, including serotyping with specific antisera. The geographical distribution, co-morbid conditions and antibiotic sensitivity patterns were analyzed. Results : A total of 15 cases of NTS were isolated of which three isolates were associated with bactaeremia. Most common isolates were S. Typhimurium and S. Enteritidis. We also isolated S. Weltreveden from two patients. Conclusion : Knowledge of the prevalent of serotypes and their sensitivities would be useful for epidemiological and treatment purposes.

Background and Objectives: Infections due to Pseudomonas aeruginosa , especially healthcare-associated infections, present a significant health problem worldwide. Drug resistance especially multidrug resistance in P. aeruginosa is on the rise. Thus the objective of this study was to determine the sensitivity pattern among clinical isolates obtained from the patients admitted to a tertiary care centre. Materials and Methods: A total of 484 non-duplicate P. aeruginosa isolates in 2014, 444 isolates in 2013, 350 isolates in 2012 and 460 isolates in 2007 were characterized according to their antibiotic susceptibility, and the trends over time were analyzed. Results: There were statistically significant increases in sensitivities of isolates P. aeruginosa from 2007 to 2014 to most of the routinely used antibiotics including Ciprofloxacin. Conclusions: A detailed genomic- and/or proteomic-level study for our isolates is much desired to understand this loss of resistance so that the same may be replicated in other bacteria.

Nocardiosis is an infrequent infection that is often misdiagnosed or under-diagnosed because of its nonspecific clinical picture and infrequent occurrence. Speciation of nocardiae is of clinical importance because of the differences in antibiotic susceptibility patterns and virulence among the species. High level of clinical suspicion and alertness on the part of the laboratory are often required to diagnose these infections. Cases have been reported from other parts of the country, but these are the first series of documented cases from Central Kerala.

Melioidosis caused by Burkholderia pseudomallei has been reported from various parts of the country and from northern Kerala. This is the first series of documented cases from Central Travancore, Kerala. The most common predisposing factor in all these three cases was diabetes mellitus followed by chronic alcoholism. Early clinical suspicion and correct microbiologic diagnosis, which help in institution of appropriate therapy, remain the key factors in reducing the mortality associated with this disease.

Context: Enterococcus is considered an important nosocomial pathogen because of its intrinsic as well as acquired antibiotic resistance. It also has the potential of transferring vancomycin resistance to other organisms such as Listeria monocytogens and Staphylococcus aureus. Aims: The objective of the present study was to determine antibiotic-resistance pattern of Enterococcus with special reference to vancomycin. Settings and Design: A total of 54 clinical isolates of enterococci were collected during the study period of 1 year at a tertiary care center in Mumbai. Material and Methods: Speciation and antibiotic sensitivity testing were done by standard procedures. Minimum inhibitory concentration (MIC) to vancomycin was carried out by agar dilution method. Results: Speciation and antibiotic sensitivity testing were done by standard procedures. The MIC to vancomycin was done by agar dilution method. Conclusions: Vancomycin, Linezolid, and Teicoplanin can be safely used for the treatment of serious enterococcal infections.

Brain abscess is an uncommon and serious life-threatening infection in children. Focal intracranial infections caused by Salmonella spp. in this age group are also rare. We report the case of a 4-month-old male infant with a frontoparietal brain abscess caused by Salmonella typhimurium , the presence of which was not suspected clinically.