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   2012| September-October  | Volume 5 | Issue 5  
    Online since December 27, 2012

 
 
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CASE REPORTS
An unusual presentation of diarrhea by Fasciolopsis Buski, Taenia Spp. and Aspergillus Spp. In a retro positive patient. A first case report from rural coastal India - Manipal, Karnataka
Mamatha Ballal, Suganthi Martena
September-October 2012, 5(5):543-545
DOI:10.4103/1755-6783.105160  
We report a rare case of diarrhea caused by Fasciolopsis buski, Taenia spp, and Aspergillus spp in a retro positive patient. A 41-year-old man presented to the gastroenterology department with complaints of bleeding per rectum. He had a history of retro positive illness for the past 15 years and is a known alcoholic. His physical and systemic examination revealed concern and laboratory tests showed values below normal range. Microbiological investigations were processed as per standard guidelines. The etiology of his diarrhea was identified as Fasciolopsis buski along with Taenia species and Aspergillus species. Following an appropriate treatment, his diarrhea resolved. To the best of our knowledge and PubMed search, this is the first case of a parasitic and fungal co-infection causing diarrhea in an immunocompromised (HIV) patient reported in literature from Manipal, India.
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ORIGINAL ARTICLES
Assessing the role of routine chest radiography in asymptomatic students during registration at a university in an endemic area of tuberculosis
Moifo Boniface, Tambe Joshua, Pefura Yone E Walter, Zeh O Fernande, Gonsu K. J. Emrick, Gonsu F Joseph
September-October 2012, 5(5):419-422
DOI:10.4103/1755-6783.105122  
Context: Routine chest radiographs are usually obtained from asymptomatic individuals during routine medical visits probably to detect the presence of occult disease. In sub-Saharan countries tuberculosis is endemic among young individuals; primary tuberculosis might be the most probable occult disease sought for. Aims: The aim was to determine the diagnostic yield and cost-effectiveness of routine chest radiography in an asymptomatic student population in Yaounde during registration at a university. Settings and Design: A cross-sectional descriptive study carried out in a University-affiliated hospital in Yaounde, Cameroon. Materials and Methods: Postero-anterior (PA) chest radiographs were obtained from students during a routine medical visit before university admission. Radiographic results were coded as normal, minor, or major findings. The estimated cost per radiograph was that of the study setting at the time of the study. Statistical Analysis Used: Epi Info software version 3.3.2 of February 9 2005 (CDC Atlanta) was used for statistical analysis. Results: Of 758 students enrolled, there were 280 males and 478 females (sex ratio 1:2). The mean age of the study population was 21 years (age range 15-33 years). All enrolled cases were asymptomatic. There were 739 normal radiographs (97.5%), while 19 radiographs (2.5 %) showed minor abnormalities. No major abnormality was seen. The estimated direct cost of all the radiographs obtained was 3,941,600 F CFA ($ 8,760). Conclusions: Routine chest radiography has a low diagnostic yield in asymptomatic students even in a setting where tuberculosis is endemic, and is therefore not cost-effective.
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Missed opportunities of immunization in under-fives in adopted area of Urban Health Centre
Hanmanta V Wadgave, Prasad D Pore
September-October 2012, 5(5):436-440
DOI:10.4103/1755-6783.105126  
Background: Immunization being one of the most cost effective public health interventions which is directly or indirectly responsible to prevent the bulk of mortalities in under-fives., thus vaccinating the children to the maximum is a great need of the future specially to reduce the child mortality and morbidity. Since, the programme of immunization on the whole was not found satisfactory in some of the states including Maharashtra. So the present study was conducted. Research question : What are the reasons of missed opportunities of immunization in under-fives? Objectives: To study the immunization status of under-fives in urban slums under Urban Health Centre and explore the reasons responsible for un-immunization or partial immunization. Materials and Methods : Community based Cross-sectional study conducted in Jan to April 2007. Total 420 under-fives were selected from six slums by simple random sampling method. Results: Out of 420 children, 270 (64.28%), 109 (25.95%) and 41 (9.76%) were fully immunized, partially immunized and un-immunized respectively. Immunization status of the children was significantly more in the children of educated mothers and child belonging to higher socioeconomic group. Lack of knowledge of immunization, ignorance about immunization of child and revisits for the immunization sessions were two main reasons (36.67% each) responsible for partial or un-immunization. Ignorance was most common reason (46.78%) responsible for partial immunization while lack of mother's knowledge regarding immunization was common (46.34%) reason of unimmunization. Conclusion: Mother's education, socioeconomic status of the family, Lack of mother's knowledge about immunization and ignorance and fear of losing daily wages were important factors responsible for un-immunization or partial immunization.
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CASE REPORTS
Silicosis presenting with simultaneous bilateral spontaneous pneumothorax
Tapan D Bairagya, Pulak K Jana, Sibes K Das, Somnath Bhattacharaya, Aparup Dhua
September-October 2012, 5(5):528-529
DOI:10.4103/1755-6783.105154  
Secondary unilateral spontaneous pneumothorax can occur in a silicosis patient. We are reporting a case of bilateral simultaneous pneumothorax in a silicosis patient.
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ORIGINAL ARTICLES
Seroprevalance of rubella in women with bad obstetric history in Tirupati of Andhra Pradesh state of India
BV Ramana, DS Murty, KH Vasudeva Naidu, B Kailasanatha Reddy
September-October 2012, 5(5):471-473
DOI:10.4103/1755-6783.105135  
Introduction: Rubella is a common cause of rash and fever during childhood. However, its public health importance relates to the teratogenic effects of primary rubella infection occurring in pregnant women, which can lead to fetal death with spontaneous abortion or to congenital defects in surviving infants. Most of the cases are asymptomatic and difficult to diagnose on clinical grounds. Materials and Methods: Detection of specific IgM antibodies by enzyme linked immunosorbent assay (ELISA) technique is a useful method for diagnosis. This study was conducted on 180 pregnant women attending antenatal clinics at Govt. Maternity Hospital, Tirupati. All the serum samples were tested for rubella-specific IgM antibodies. Results: A seropositivity of 12.67% was observed among cases with bad obstetric history and 6.67% in normal pregnant women. Within the test group, high seropositivity (13.33%) was observed in women with repeated abortions followed by in cases of intrauterine death (12.73%). Conclusions: The results indicate high prevalence of rubella in our population. All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and fetal outcome.
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Prevalence of inducible clindamycin resistance in clinical isolates of coagulase negative staphylococci at a tertiary care hospital
Neha Bansal, Uma Chaudhary, Vivek Gupta
September-October 2012, 5(5):427-430
DOI:10.4103/1755-6783.105124  
Background : Coagulase negative staphylococci (CoNS) are an important group of multi-drug resistant nosocomial pathogens. Clindamycin resistance in staphylococci can be either constitutive or inducible. Clindamycin has been used successfully to treat pneumonia, soft-tissue and musculoskeletal infections due to methicillin-resistant CoNS (MRCoNS) in adults and children, but this matter is complicated by the possibility of inducible macrolide-lincosamide streptogramin B resistance (MLSBi). Aims: The present study was aimed to determine the incidence of inducible clindamycin resistance in CoNS isolates in our hospital using D-test, relationship between MRCoNS and MLSBi isolates, association of MLSBi isolates with community or nosocomial setting and treatment options for these isolates. Materials and Methods : A total of 250 consecutive, non-duplicate strains of CoNS were isolated from various clinical specimens, both from indoor and outdoor patients. After determining methicillin resistance, D-test was performed on all erythromycin-resistant and clindamycin-sensitive isolates to detect inducible clindamycin resistance. Results : Among 250 CoNS isolates, 89 (35.6%) were found to be MRCoNS and 20% had MLSBi phenotype. MRCoNS showed higher inducible as well as constitutive resistance (p<0.0001) to clindamycin as compared to methicillin-sensitive CoNS (MSCoNS). All isolates having MLSBi phenotype were sensitive to vancomycin and linezolid. Conclusions : Clindamycin is a useful drug in the treatment of staphylococcal infections. Hence, routine testing of staphylococcal isolates for inducible clindamycin resistance is strongly recommended.
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Spondilodiscitis due to Mycobacterium tuberculosis in HIV and non-HIV-infected patients: Eleven years experience in a referent Hospital of infectious diseases in Argentina
Marcelo Corti, Maria F Villafa˝e, Norberto Trione, Claudio Yampolsky, Leonardo Gilardi
September-October 2012, 5(5):450-452
DOI:10.4103/1755-6783.105129  
Background: Tuberculosis (TB) is an emerging health problem despite the advances in the methods of diagnosis and treatment. The resurgence of tuberculous spondilodiscitis (TBSD) or Pott's disease can be expected to be associated with a concomitant increase in the incidence of extra-pulmonary TB. Aim: To describe the clinical features, imaging findings, and laboratory diagnosis in a group of patients with TBSD. Materials and Methods: From January 1 st 2000 to December 31 st 2010, we retrospectively reviewed 22 cases of spinal TB. Only those with positive culture results and/or characteristic clinical and pathological findings were enrolled. Demographic data, comorbilities, clinical manifestations, time up to the definitive diagnosis, outcome and sequelae were considered. Results : During the study period, 22 patients were diagnosed with TBSD; 14 were men and 8 women with a median of age of 34 years at the time of diagnosis. The median duration of symptoms before the TBSD diagnosis was 120 days (range 30 to 360 days). At the time of diagnosis, fever and back pain were the most common clinical symptoms; 7 patients (32%) had fever and 21 (95%) had spinal pain; eleven patients (50%) had constitutional symptoms; 6 (27%) had respiratory symptoms and 3 (13.6%) had neurological manifestations. Magnetic resonance imaging (MRI) was performed in 9 (40%) cases, computed tomography (CT) in 7 patients (32%), and abdominal ultrasound in 6 cases (27%). The lumbar spine was the most commonly involved site (14 patients, 64%); thoracic spine was involved in 2 patients (9%); dorsolumbar spine was compromised in 4 cases (18%). Cervical spine was only involved in one patient (4.5%) and the last patient (4.5%) presents a global spinal involvement (cervical-thoracic and lumbar spine). Conclusion: Insidious clinical course and ambiguous manifestations of TBSD often delay the accuracy of diagnosis. Spinal TB should be included in the differential diagnosis of patients with prolonged back pain and fever.
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Serum HSV-1 and 2 IgM in patients of sexually transmitted diseases
Dharmishtha G Tada, Neeta Khandelwal
September-October 2012, 5(5):479-482
DOI:10.4103/1755-6783.105138  
Background: Herpes simplex virus type1 & 2 (HSV 1 &2) are the causative agent for genital herpes. Aim: To examine Serum HSV-1 and 2 IgM in all type of STD (sexually transmitted disease) patients including Human immunodeficiency virus (HIV) infection and also to evaluate correlation of Serum HSV-1 and 2 IgM in these patients. Materials and Methods: 150 patients attending the STD clinic attached to a tertiary care hospital of Ahmedabad were included in the study. These all patients were screened for HIV-1 and 2 antibodies. Serum HSV-1 and 2 IgM correlations with HIV infection and clinical manifestations of genital herpes patients and other non herpetic STD patients were studied. Results: The overall Serum HSV-1 and 2 IgM in STD seroprevalence was 15.66%. Female have significant higher prevalence (p < 0.05). STD cases and HSV seroprevalence were specially concentrated in persons aged 21 to 30 years. Among those positive with HSV, the distribution of STD are wide spread and found in non herpetic group at high frequency. Out of total 23 Serum HSV-1 and 2 IgM positive, 5 (21.73%) were HIV reactive. Discussion and Conclusion: Though Serum HSV-1 and 2 IgM in sexually transmitted diseases is less diagnostic, it helps to see the iceberg part of the infection among the population concerned recently. Putting STD surveillance systems in place specially in areas with high prevalence of HIV will be crucial in monitoring changes so that appropriate adjustments can be made to treatment schedules to make them more cost effective.
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CASE REPORTS
Primary intramuscular hydatid cyst: A rare case report
Sankappa P Sinhasan, A Palachandra
September-October 2012, 5(5):546-548
DOI:10.4103/1755-6783.105161  
Hydatid disease has a worldwide distribution and causes health problems in endemic countries. The prevalence of primary muscular hydatid disease is reported to be only 0.5% because muscle is an unfavorable site for infestation as a result of its high levels of lactic acid. Primary intramuscular hydatid cyst presents a diagnostic problem not only because of the unusual location and low prevalence, but also because complicated cysts may imitate solid or complex lesions. We report an unusual case of primary hydatidosis of the calf muscles, in which a wide excision was performed without causing any damage to the cyst wall. Injudicious approach in the management of these rare presentations may be the root cause of severe anaphylactic shock and systemic dissemination. Intramuscular hydatid cysts grow gradually and may mimic a soft tissue tumor; thus, the diagnosis of soft-tissue hydatid cysts needs a high index of suspicion.
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Two case reports of ophthalmomyiasis externa caused by Oestris Ovis larvae
Harsh Goel, Rajiv Tangri, Ravneet Kaur, Jyoti Jain
September-October 2012, 5(5):549-550
DOI:10.4103/1755-6783.105162  
Myiasis is the infestation of the body by the larval forms (maggots) of dipterous flies. Ophthalmomyiasis or ocular myiasis refers to the inflammations that involve the eye and ocular adnexa. This may be external, internal, or orbital. Less than 5% of human myiasis cases involve eye. Ophthalmomyiasis varies in severity, ranging from simple irritation to complete destruction of the orbit. The condition is often misdiagnosed as an acute conjunctivitis. Globally, so far, most cases have been reported from rural areas. Here, we present 2 case reports. Both patients belonged to an urban area. The larvae were successfully removed, and both cases are being followed. These cases show that this infection is probably more common in urban areas than reported.
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Co-existence of typhoid fever and hepatitis A
Syed Ahmed Zaki, Preeti Shanbag
September-October 2012, 5(5):551-552
DOI:10.4103/1755-6783.105163  
Typhoid fever and viral hepatitis are endemic in many developing countries. Both are transmitted by the feco-oral route and are associated with poor sanitation. Co-existence of both the infection is possible posing a diagnostic dilemma for the treating physician. We report a 7-year-old boy, who had co-existent typhoid fever and hepatitis A infection and was managed successfully. An aim of this report is to discuss the clinical scenario and presentation when typhoid fever and hepatitis A occur concurrently in a patient.
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An unusual case of urethral polyp
Anadi R Chowdhury, Ranjan Dey, Palash Bhattacharya, Supriyo Basu
September-October 2012, 5(5):530-531
DOI:10.4103/1755-6783.105155  
Rhinosporidiosis is a chronic granulomatous disease caused by fungus Rhinosporidium seeberi affecting most commonly the anterior nares. Urethral involvement is extremely rare. We present such a case in a 61-year-old man with intermittent bleeding per urethra and fleshy mass coming through the urethral meatus. On histological examination of hematoxylin-eosin-stained smears, the lesion showed numerous sporangia mixed with inflammatory infiltrates and occasional giant cells, beneath the urethral squamous epithelium. The mass was excised and fulguration of the base with diathermy was offered for cure.
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Pleural effusion: A rare complication of co-infection of hepatitis A and hepatitis E
Kalenahalli Jagadish Kumar, Halasahalli C Krishna Kumar, Vadambal G Manjunath, Lingappa Umesh
September-October 2012, 5(5):532-533
DOI:10.4103/1755-6783.105156  
Hepatitis A (HAV) is a benign self-limiting infection, spread chiefly by faeco-oral transmission and is common in the developing countries. The main complication of HAV infection is fulminant hepatitis, which occurs in less than 1% of cases. Extra-hepatic complications involving other systems, can occur in HAV infection. Pleural effusion also represents a benign complication of acute hepatitis A infection. We describe here a case of co-infection of HAV and Hepatitis E who developed pleural effusion.
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Enteric fever complicated by multiple splenic abscesses
Narayanappa Doddaiah, Rashmi Nagaraj, Mathod Ganesha Rao Anil Kumar, Rajani Hassan Srinivasa Murthy
September-October 2012, 5(5):534-536
DOI:10.4103/1755-6783.105157  
Enteric fever complicated by splenic abscess is a rare entity in pediatric age group. It is usually a part of disseminated infection. There can be single or multiple abscesses. Single abscess most commonly responds to conservative management with appropriate antibiotics and ultrasound-guided percutaneous drainage of the abscess. However, multiple abscesses require splenectomy. The child presented here had multiple splenic abscesses as a complication of enteric fever. There was no response to conservative management and hence he had to undergo splenectomy. So, in children with enteric fever, it is strong suspicion, which helps in identifying complications early and treating them accordingly. Salvaging the spleen is not possible in case of multiple splenic abscesses.
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Disseminated cutaneous nocardiosis in case of nephritic syndrome
Swapna Mali, B Tasneem, Arun Doshi, Rajesh Sharma
September-October 2012, 5(5):537-539
DOI:10.4103/1755-6783.105158  
Dissemination of the pulmonary nocardiosis most commonly occurs to the sites like brain, kidney, chest wall, and skin. Dissemination to the skin and the subcutaneous may occur but rarely been observed in clinical settings. Here, we present an unusual case of disseminated cutaneous nocardiosis from pulmonary nocardiosis in a patient of nephritic syndrome who was on steroids and immunosuppressants. This case highlights the importance of considering nocardiosis in differential diagnosis in case of immunocompromised patients presenting with pulmonary complaints and cutaneous lesions.
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Fatal septicemia by multidrug-resistant Enterococcus faecium in a case of exomphalos minor
Mahantesh V Parande, Aisha M Parande, Basappa G Mantur, Shailesh S Patil
September-October 2012, 5(5):540-542
DOI:10.4103/1755-6783.105159  
Exomphalos minor is one among uncommon disorders of the umbilical region. Here, we report a fatal case of exomphalos minor with enterococcal septicemia. A male baby, born with exomphalos minor, developed clinical features of septicemia on the fourth postnatal day. Blood samples were collected by venepuncture from two sites for culture. Enterococcus faecium was isolated from both the blood samples. The swabs collected from the site of exomphalos also yielded growth of Enterococcus faecium, confirming the source of infection. The antibiogram with Minimum Inhibitory Concentrations (MIC) for various antibiotics was done for isolates from all three sites, which was similar. The isolate was resistant to multiple antibiotics with high level aminoglycoside resistance. The baby was treated with antibiotics and other supportive measures. However, the baby succumbed to the septicemia. As per our knowledge, this is the first reported case of fatal septicemia by multidrug-resistant Enterococcus faecium in a case of exomphalos minor.
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Unusual presentation of giant condylomata acuminata of the vulva: A case report and review of literature
Ibrahim A Yakasai, Idris S Abubakar, Saidu A Ibrahim, Rabi'u Ayyuba
September-October 2012, 5(5):508-510
DOI:10.4103/1755-6783.105146  
The lesion of Condylomata Acuminata popularly known as venereal warts are lesions which are generally diagnosed based on their warty appearance. The mode of treatment range from application of podophyllin to surgical excision by cauterization. A case of unusual presentation of giant Condylomata in a 26 year old, single, nulliparous, retroviral disease positive woman is presented and the literature reviewed. She presented with 18 months history of rapidly progressive vulval swelling and associated itching, contact bleeding, malodorous vaginal discharge and difficulty in walking. She had previously been treated with podophyllin without success. The growth measured 40×30 cm and was successfully excised with no evidence of malignancy.
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Acute abdomen by gossypiboma
Sant P Kataria, Monika Garg, Sanjay Marwah, Divya Sethi
September-October 2012, 5(5):511-513
DOI:10.4103/1755-6783.105147  
Retained foreign bodies after surgery is a quite rare condition, which can have medico-legal consequences. Foreign bodies forgotten in the abdomen include towels, artery forceps, pieces of broken instruments or irrigation sets, and rubber tubes. The most common surgically retained foreign body is the laparotomy sponge. Such materials cause foreign body reaction in the surrounding tissue. The complications caused by these foreign bodies are well known, but cases are rarely published because of medico-legal implications. We report a case of 41-year-old female who was admitted with complaints of intestinal obstruction who had a previous history of hysterectomy performed 2 months back, at another hospital. Pathologists must be aware of this entity and its proper reporting, as the cases are liable to go to court. Surgeons must recognize the risk factors that lead to a gossypiboma and take measures to prevent it.
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Mucormycosis of pouch of douglas in a diabetic lady: Report of a rare case
Santosh Kumar Mondal, Palash Kumar Mandal, Tanmoy Kumar Mondal, Nandita Basu
September-October 2012, 5(5):514-516
DOI:10.4103/1755-6783.105148  
Mucormycosis is a severe fungal infection which is rare in clinical practice. This infection is usually acquired by inhalation; other portals of entry are ingestion and traumatic implantation, especially in immuno-compromised patients. Here, we present a case of mucormycosis in a 44 year old diabetic woman. The patient had collection of fluid in the Pouch of Douglas and history of bleeding per vagina. Hysterectomy was done which showed a blackish serosal surface of the posterior uterus. Subsequent investigations revealed mycormycosis affecting the pouch of Douglas. Patient was treated with liposomal amphotericin B and is now keeping well.
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Non-inflammatory infestive benign acanthotic papule of the skin: Histopathological evidence
Mohammed Naim, Syed S Amin, Shamsuz Zaman, Anjum Naim
September-October 2012, 5(5):517-519
DOI:10.4103/1755-6783.105149  
We report histopathological evidence of mycoplasma infestation of the squamous epithelium presenting non-inflammatory benign acanthotic papule of the skin in an adult male, not reported in the previous literature. Sections showed hyper-chromatic basal layer with marked acanthosis and inclusions with nucleic body surrounded by cytoplasm devoid of cell wall. Histopathological evidence was diagnostic of mycoplasma infested non-inflammatory benign acanthotic papule of the skin. Nuclear and cytoplasmic microbial inclusions in the epithelial cells, and keratinocytic and cytolytic changes could be the source of signals to the basal strata for benign epitheliomatous proliferation, giving rise to non-inflammatory benign acanthotic papule.
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Cerebral venous thrombosis as a complication of chicken pox
Bindu Menon, Rajeev Goyal
September-October 2012, 5(5):520-522
DOI:10.4103/1755-6783.105151  
Chickenpox is one of the classic childhood disease. It is usually a benign self limiting exanthematous illness. Recently chicken pox has been reported in adults with more severe systemic and neurological complications. Cerebral venous thrombosis (CVT) is a life threatening disorder if not treated in time. We report a patient with post varicella CVT which has not been previously reported.
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Coinfection with hepatitis a and leptospira in jaundice children
Kalenahalli J Kumar, Nagadenahalli A Prasad, Vadambal G Manjunath, Lingappa Umesh
September-October 2012, 5(5):523-524
DOI:10.4103/1755-6783.105152  
Mixed infection is a challenge to the treating clinician. Infection like Hepatitis A and Leptospirosis are prevalent in developing countries. The spectrum of clinical severity of both Leptospira and Hepatitis A ranges from mild infection to jaundice. Awareness and appropriate use of investigations can overcome the diagnostic dilemmas.
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Rare site for tubercular osteomyelitis with HIV infection
Vijay Bohra, Nardeep Naithani, Prafull Sharma
September-October 2012, 5(5):525-527
DOI:10.4103/1755-6783.105153  
Tuberculosis of the scapula is a rare clinical entity. Few cases have been reported in the literature so far. We report a case of tuberculosis of the scapula in a HIV positive patient, which was managed successfully with antitubercular drugs. This case illustrates the difficulties in diagnosing tubercular osteomyelitis of the scapula as it has an insidious onset, paucity of constitutional symptoms and frequent absence of associated pulmonary involvement. Pitfall in diagnosis is the delay in considering the diagnosis of bony tuberculosis, especially in patients who have normal chest radiographs.
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EDITORIAL COMMENTARY
The immunization gap
Abubakar Yaro
September-October 2012, 5(5):409-410
DOI:10.4103/1755-6783.105120  
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LETTERS TO THE EDITOR
Human parasitosis in post-crisis nuclear leakage: A topic for concern in tropical medicine
Viroj Wiwanitkit
September-October 2012, 5(5):553-553
DOI:10.4103/1755-6783.105164  
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Community-acquired Acinetobacter skull base osteomyelitis in an immunocompetent adult
Amit Agrawal, Varsha A Singh, Subhash Goyal, Amit Mittal, Sunil Sampley, Vishal K Goel
September-October 2012, 5(5):554-555
DOI:10.4103/1755-6783.105165  
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ORIGINAL ARTICLES
Ocular manifestations in human immunodeficiency virus/acquired immuno deficiency syndrome patients and their correlation with CD4+ T-lymphocyte count
Ram Lal Sharma, Praveen Panwar, Ravinder Gupta, Ashok Sharma, Kulbhushan Chaudhary
September-October 2012, 5(5):474-478
DOI:10.4103/1755-6783.105136  
Aim: To study the various ocular manifestations in HIV/AIDS patients and their correlation with CD4+ cell count. Materials and Methods: In this study, 125 HIV-positive patients were studied for ocular features of HIV in the Department of Ophthalmology and Department of Medicine, for a period of 1 year. Statistical Analysis: Correlation of ocular findings with CD4+ cell count was analyzed using the Chi-Square test and 'P' valve was calculated at 95% confidence limit. Results: Out of 125 HIV-positive patients, 70 were men and 55 were women. Ninety-seven (78%) were in the age group of 21-40 years. Ocular findings were seen in 41(33%) patients. Heterosexual transmission was the most common risk factor 118(94%). HIV retinopathy was the most common ocular lesion in 19 patients (46%) followed by anterior uveitis in 4 patients (10%). Among systemic lesions, pulmonary tuberculosis was common in 27 (22%) patients followed by oral candidiasis in 15 (12%) patients. Out of 41 (33%) ocular finding positive patients, 35 (85%) had CD4+ cell count less than 200 cells/mm 3 . Conclusion: HIV retinopathy and opportunistic ocular infections were common in HIV/AIDS patients. Ocular lesions were more common when CD4+ cell count was less than 200 cells/mm 3 . All patients who had CD4+ cell count less than 200 cells/mm 3 must undergo complete ophthalmic checkup to rule out ocular lesions.
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Qualitative D-Dimer in deep vein thrombosis: A single center prospective study from Kashmir India
Davinder Pal Singh, Ghulam Nabi Dhobi, Muzafar Naik, Fayaz Sofi, Bavneet Kour Bali, Feroze Shaheen, Younis Shah
September-October 2012, 5(5):411-418
DOI:10.4103/1755-6783.105121  
Objective: The aim of our study was to study the significance of qualitative D-dimer in the diagnosis of deep vein thrombosis. Study Design: Prospective analysis. Setting: Tertiary care hospital. Materials and Methods: One hundred and twenty nine patients of suspected deep vein thrombosis were included in the study and further categorized as likely or unlikely to have deep vein thrombosis on Wells scoring system. The patients in both the likely and unlikely categories were then randomly assigned to undergo D-dimer testing (D-dimer group) or to undergo ultrasound imaging alone (control group). The patients with pre text clinical probability score as unlikely and with negative D-dimer test were considered not to have DVT. The primary event was recurrent venous thromboembolism in both the groups during three months of follow-up. Results: A total of one hundred and twenty nine patients with suspected DVT were included in the study. Sixty five patients were randomly assigned to D-dimer group and sixty four to the doppler group. The diagnosis of DVT was established in 41 (31.78%) patients. Among patients in whom DVT was ruled out by the initial diagnostic evaluation one case of deep vein thrombosis was confirmed in the D-dimer group (1/55, 1.8%; 95% confidence interval, 1.6 to 5.2%) and two cases in the Doppler group (2/51, 3.92%; 95% confidence interval, 1.5 to 9.34%) during three months of follow-up. The use of D-dimer resulted in lesser number of USG (0.66 tests per person) in the D-dimer group as compared to (1.23 tests per person) in the Doppler group. Forty patients (31%) in the D-dimer group did not require ultrasound imaging. Conclusion: The diagnostic performance of qualitative D-dimer assay combined with a clinical pre text probability score can also rule out DVT safely in low probability scores without significantly compromising safety.
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Efficacy of fipronil gel over imlprothrin +cypermethrin aerosol in control of cockroaches (Field Trial)
Vijender K Agrawal, Ashok Agarwal, Varsha Choudhary, Arun Singh, Pooja Agrawal
September-October 2012, 5(5):423-426
DOI:10.4103/1755-6783.105123  
Background and Objectives: Cockroaches are offensive pests visually and expel unpleasant smelling secretion that spoils the flavor of food and environment. This trial was done to test Strikeout bait gel (fipronil 0.055%) developed by Parijat Industries (India) Pvt. Ltd. for its efficacy against Periplaneta americana and Blatella germanica, under field conditions in certain catering establishments of a city in Uttar Pradesh. Material and Methods: Ten catering establishments with high infestation based on pretreatment cockroach density assessment (Four for fipronil gel, four for imlprothrin+ cypermethrin aerosol and two without any treatment to act as a control) were considered for inclusion in trial. Single application of fipronil gel/ imlprothrin+ cypermethrin aerosol was used as crack and crevice treatment. The visual assessment data for cockroach density in treatment and control catering establishments were considered for computation of percent reduction of cockroach infestation in the respective catering establishments. Results: Single application of fipronil gel was able to reduce cockroach infestation up to 96.0% at the end of 12 weeks whereas it was 20% in imlprothrin+ cypermethrin aerosol treated areas. Differences were found statistically significant. However, imlprothrin+ cypermethrin aerosol was more effective (52.0%) in reducing the cockroach density by first week in comparison to fipronil gel (47.8%) but its efficacy started declining after 5th week onwards. Interpretation and Conclusion: The study reports the efficacy of Strikeout bait gel (fipronil 0.055%) for control of cockroaches in catering establishments. The application Strikeout bait gel (fipronil 0.055%) was found more convenient to both operators and clients and there was minimal disruption at workplace.
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Environmental sanitation and health facilities in schools of an urban city of south India
Nitin Joseph, Unnikrishnan Bhaskaran, Ganesh Kumar Saya, Shashidhar M Kotian, Ritesh G Menezes
September-October 2012, 5(5):431-435
DOI:10.4103/1755-6783.105125  
Background : Environmental sanitation and health facilities in schools are an important public health issue. Aims : To assess the school environment, sanitation and health related facilities and to compare the availability of these facilities between government, aided and private schools. Materials and Methods : This cross sectional study was done in 30 schools in Mangalore city of south India in February 2010. Results : Out of the 30 schools surveyed, four were government, 12 were aided and 14 were private schools. Overcrowding was seen in one third of schools. The recommended minus desks was lacking in 23(76.7%) and chairs with back rest was lacking in 11(36.7%) schools. More than a quarter of schools had no drinking water purification facility. Water storage units were not cleaned periodically in 6(20%) schools. Quarter of all government schools and half of all aided schools had no dining hall for serving mid-day meals. Toilets were not adequate in 10(33.3%) and it was not separated for boys and girls in 8(26.7%) schools. Four of the surveyed schools had no medical examination of students and in 13(43.3%) schools daily morning inspection by teachers was not done. Hardly few schools had staff trained to deal with medical emergencies and in counselling activities. None of the schools had an immunization register. Although the performance scores between the types of schools did not differ significantly, the combined performance of only private schools were found to be satisfactory. Conclusion : A good number of schools in this urban area were found to be falling short of several essential requirements regarding sanitation and health facilities which needs to be rectified.
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Role of catch-up campaigns in improving immunization services in a developing country
Giridhara R Babu, TN Sathyanarayana, Sayantee Jana, Siddhartha Nandy, Muhammad N Farid, SM Sadhana
September-October 2012, 5(5):441-446
DOI:10.4103/1755-6783.105127  
Background: Bellary district of India had highest number of Polio cases in the world during the year 2003. This is mainly because of low level of routine immunization coverage. Successful implementation of supplementary immunization activities interrupted Polio transmission in 2003. It is important to sustain the gains made in polio immunization as well as make attempts to improve the immunization coverage against other vaccine preventable diseases. We wanted to look at the immunization coverage rates before and after the catch up campaigns to strengthen routine immunization services in this high-risk district. Aims: Our objective was to evaluate the impact of catch up campaign through estimation of immunization coverage after conclusion of catch-up campaigns in the district of Bellary. Settings and Design: The evaluation data is from a cross sectional study done in Bellary district, India by following multi stage and systematic random sampling. Materials and Methods: The study was done in three stages; In stage one, the district specific DLHS data was analyzed. In stage two; systemic issues were identified by going through immunization registers, records and identified key reasons for low vaccination coverage. In stage three, immediately after catch up immunization sessions, the coverage rates were captured using simple random sampling, and compared with DLHS data. Statistical Analysis: Data analysis was performed using SPSS Statistics 17.0 (Rel. 11.0.1 2001-SPSS Inc), R 2.11, Microsoft Excel (MS office, Version 2007, Microsoft Corporation, USA). Results: The results demonstrate that the coverage for all antigens improved due to the conduct of catch-up campaigns. Conclusions: This study compares estimates of the age-specific population immunization coverage against BCG, OPV, DPT, TT, and Measles before and after the catch up campaigns. Catch-up sessions help to address systemic issues related to routine immunization, and sustain high immunization coverage in developing countries like India.
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The bug with the metallic gun - in the corridors of a peripheral medical college and hospital, India
Dibyendu Banerjee, Tarun Kr. Pathak, Parthasarathi Satpathi, Mallika Sengupta, Manideepa Sengupta
September-October 2012, 5(5):447-449
DOI:10.4103/1755-6783.105128  
Context: Pseudomonas aeruginosa is an obsessive invader in the hospitals worldwide. It has powerful antibiotic resistance mechanisms, one of such being metallo beta lactamase, which is taking away from our hands our last resort, carbapenem group of antibiotics, to fight them. Not only they possess this metallic gun, they are exceptionally good gun dealers also, as the genes producing this metallo beta lactamase resides on plasmids and hence, are easily and efficiently transferrable among other bacteria, Thus it becomes a present day concern to detect the presence of MBL positive Pseudomonas aeruginosa in every hospital to have a powerful and effective antibiotic regimen in the future also. Aims: To determine the presence and extent of MBL positive Pseudomonas aeruginosa in a Midnapore Medical College, West Midnapore district, West Bengal, India. Materials and Methods: A total of 630 samples were processed, out of which 112 isolates of Pseudomonas aeruginosa were found. Among these, 20, were found to be imipenem resistant and these were subjected to EDTA impregnated imipenem disc potentiation test. Discussion: Out of 112 P. aeruginosa, 8 isolates (7%) turned out to be MBL producers. Also, a high susceptibility pattern was found for aminoglycosides. Conclusion: Although we found a low prevalence of MBL producing P. aeruginosa, still it is worrisome. Constant vigilance and careful selection of antibiotics are necessary.
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Clinical and laboratory aspects of adults and children admitted with meningococcal meningitis to a tertiary hospital in Fortaleza, Ceara, Brazil
Elizabeth F Daher, Rafael C. L. Maia, Bruna S Ciarlini, Sergio L. A. da Silva, Eveline C da Silva, Geraldo B Silva Junior
September-October 2012, 5(5):483-488
DOI:10.4103/1755-6783.105139  
Background: Meningococcal meningitis (MM) persists in developing countries in forms of outbreaks, epidemics or sporadic cases, resulting in considerable morbidity and mortality. The aim of this study is to evaluate the clinical and laboratory aspects of adults and children with MM. Materials and Methods: This is a retrospective study with 291 patients diagnosed with MM, hospitalized in a tertiary hospital in Fortaleza, Northeast of Brazil, between 1999 and 2009. We analyzed epidemiological, clinical and laboratory findings. Results: The mean age of patients was 13.7 ± 12.8 years, ranging from newborn to 71 years, 59% were 12 or less, mostly male (57.3%). Average time between symptom onset and hospitalization was 2.21 ± 2.62 days. There was associated meningococcemia at 22.3% of cases. The most common manifestations were fever (92.7%), vomiting (80.4%), headache (68.7%), neck stiffness (64.9%) and petechiae (31.9%). Laboratory tests showed an average Hb 11.1 ± 1.7 g/dL, WBC 17.94 ± 17.29 x 10΃/mm΃, platelets 20.58 ± 11.53 x 103/mm3. Sodium (134.66 ± 14.89 mEq/l), potassium (4.2315 ± 3.8805 mEq/l), urea (35.66 ± 35.96 mg/dl), creatinine (0.77 ± 0.77 mg/dl), AST (48.81 ± 62.73 units/L), and ALT (37.93 ± 36.78 units/L) were other laboratory parameters. There was record of 25 deaths (8.5%). Conclusion: Most were children below 12 years, suggesting the vulnerability of this age group for MM. There was no statistical difference between adults and children with regard to laboratorial parameters, but the data show numbers that can represent a laboratory profile of the disease.
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A study of clinical characteristics and trend of different types of tuberculosis in coastal South India
S Rama Prakasha, G Suresh, Ivor Peter D'sa, S Ganesh Kumar, Ramakrishna Rao, Manamohan Shetty
September-October 2012, 5(5):489-494
DOI:10.4103/1755-6783.105141  
Background: Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis. The prevalence and the mortality due to tuberculosis are reducing in India, with an increasing number of suspects being examined and treated under Revised National Tuberculosis Control Program (RNTCP). Aim: The primary objective of this study was to describe the basic demographic, clinical characteristics, trends of various types of tuberculosis and program specified treatment protocols of patients registered for TB treatment in this single center attached to medical college hospital under RNTCP. Materials and Methods: This was a retrospective, record-based study of patients of all types of tuberculosis from January 1995 to December 2010 in all age groups, evaluated at K. S. Hegde Medical College and Hospital, Deralakatte, Mangalore, Karnataka, India. Results: A total of 1058 cases were registered and treated under Directly Observed Treatment Short-course (DOTS) during this period. Males (689, 65.12%) contributed to more number of cases than females (369, 34.88%). Of 1058 cases, 400 (37.81%) were found to be smear positive and among them 297 (74.25%) were males and 103 (25.75%) were females. Among 400 smear positive cases, 322 were new smear positive cases and 78 were Re-treatment Smear Positive cases. The Sputum Positive Ratio was ranging between 7.8% and 23% during the study period. 621 cases (58.7%) were classified as Pulmonary and 437 (41.3%) were classified as Extra Pulmonary. Among 621 Pulmonary cases, 221 (35.59%) were treated according to radiological criteria alone (X-ray positive alone). 778 cases received Cat-I treatment, 135 cases received Cat-II treatment, and 141 cases received Cat-III treatment. CXR positive+ EPTB cases contributed to 62.2% (n = 658) of total tuberculosis cases registered for treatment. Conclusion: High proportion of TB patients with EP-TB and its increasing trend along with higher reporting of sputum smear-negative PTB is a major concern for the health authorities in this area.
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A single centre retrospective study to analyze and compare mortality amongst geriatric and non-geriatric population presenting to a tertiary care hospital in Delhi
Subhash Giri, Mukul P Agarwal, Shashank Garg, Sourabh Aggarwal, Raya Ranga, Vishal Sharma
September-October 2012, 5(5):495-497
DOI:10.4103/1755-6783.105142  
Introduction: India is a country currently undergoing a phase of demographic transition. Increased fertility rate and decreased mortality rate due to advancing health care facilities have contributed to the aging population. The geriatric age group is vulnerable period of life and has health problems and related morbidity and mortality which are very different from other age groups. The present study was conducted to compare and analyze the causes of mortality among patients of geriatric and non geriatric age group admitted to medical emergency in a Government run tertiary level teaching hospital in New Delhi. Materials and Methods: The data for all the patients admitted in the medical emergency department from January 2008 to December 2008 were obtained from Medical Records Department. The age of 65 was used as a demarcation between geriatric and non - geriatric groups for the purpose of study. Total number of patients who died from different causes were noted and sub-classified according to the cause of mortality. The percentage mortality due to different causes was calculated for both age groups and compared and analyzed. Results: The study revealed that a total of 10,711 patients were admitted to the medical emergency of which 2035 were in geriatric group and 8676 were in non geriatric group. The mortality rate in geriatric and non geriatric population was 14.3% and 7.65% respectively which was significantly higher in geriatric population statistically. CAD and COPD were the commonest disease responsible for mortality among geriatric patients while the leading cause for mortality among non geriatric group was infectious disease. Discussion: The geriatric population because of its widespread economic, social and health care implications needs utmost care to decrease associate morbidity and mortality and to improve the quality of life. Geriatrics as a separate branch in not too much developed and much needs to be done in this aspect to improve the health care delivery.
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The frequency study of trichomoniasis in women referred to gynecology clinic of Ayatollah Rohani Hospital, Babol, Iran, in 2010
Narges Kalantari, Salman Ghaffari, Sedigheh Esmaeilzadeh
September-October 2012, 5(5):498-501
DOI:10.4103/1755-6783.105143  
Background and Objectives: Trichomonas vaginalis is a flagellate protozoan parasite commonly found in the human genitourinary tract. The main aim of this study was to study of T. vaginalis infection among symptomatic women and to compare the clinical findings with laboratory results. Materials and Methods: In this study, a total of 76 nonpregnant women participated. All of them were interviewed and examined physically. Two swabs of vaginal discharge were obtained to perform wet-mount and Giemsa staining methods. Results: The mean age of the studied population was 31.69 years. The overall frequency of trichomoniasis was 1 out of 76 (1.3%) as obtained with both laboratory methods. The infected case was 28 years old. Her clinical findings were abdominal pain and simple discharge. Conclusions: The frequency of trichomoniasis was low in the current work. This study suggests that multilaboratory diagnostic methods should be carried out before clinical decision and treatment.
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Comparison of Lung graphy and thorax computed tomography findings in children with Tuberculin skin test positive
Evrim Efe, Vefik Arica, Murat Dogan, Sešil Gunher Arica
September-October 2012, 5(5):502-507
DOI:10.4103/1755-6783.105144  
Aim: Benefit of thorax computed tomography was investigated when lung graphy remains insufficient in the diagnosis of tuberculosis. Materials and Methods: 55 patients across children with tuberculin skin test (TST) positive nonspecific symptom who applied to the tuberculosis polyclinic of our hospital were investigated between ages of 0-18, determined positivity in their TST test or with tuberculosis contact story. Age, gender, complaining, TST results, existence/number of BCG scar, underlying disease, contact status, cigarette exposure, laboratory findings, Lung graphy and thorax CT findings of patients were compared. Results: Average age of cases was 110, 38±42, 8 months. Lung graphy results of 36.4% of cases were abnormal while 63.6% were normal. Results of 30.9% (n=17) were abnormal while 69.1% (n=38) of cases were normal. No compliance is observed between results of CT and Lung graphy (p<0.05). Lung graphy was found to have a low positive true diagnosis value, a higher negative true diagnosis value. A significant difference is observed between tuberculosis sighting case and scar numbers of BCG (p<0.05). Conclusion: Taking lung graphy and thorax CT is beneficial and significant in the investigation of tuberculosis disease in patients with positivity of tuberculin skin test. Computed tomography is more sensitive method in comparison to lung graphy in terms of all findings.
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A study on mental distress among MBBS students in a Medical College, Kolkata, India
Chitra Chatterjee, Pankaj K Mandal, Sarmila Mallik, Nirmalya Manna, Jadab C Sardar, Samir Dasgupta
September-October 2012, 5(5):453-457
DOI:10.4103/1755-6783.105131  
Background: The undergraduate medical training period is a stressful period. In the recent years, due to growing competitiveness and aspiration for achievement the pressure on the students has increased manyfolds and makes the medical students more vulnerable for developing mental distress and thus contributes to poor academic performance and substance use. So an observational, cross-sectional study was conducted among the undergraduate students in a medical college to study the prevalence of mental distress among the undergraduate students of Medical College, Kolkata, India and to find out the correlation between mental distress and explanatory variables among the study population. Materials and Methods: It was a cross-sectional, observational study among the undergraduate students in a medical college, Kolkata, India and used SRQ-20 for the assessment of mental distress. Result: The prevalence of mental distress was 14.5%. Present occupancy, parent's occupation, attempt in MBBS entrance examination, students who could not cope with the situation, socioeconomic status, and place of residence were found as risk factors of mental distress. A total of 78% of the explanatory variables could be explained by binary logistic regression analysis. Conclusion: Considering these risk factors, preventive measures should be undertaken to reduce the mental distress and its consequences.
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Morbidity pattern and treatment in India
Sarda Prasad
September-October 2012, 5(5):458-467
DOI:10.4103/1755-6783.105132  
To achieve MDGs, it is important to understand ailing and hospitalization that occurs in India. In this regard, data were used from two surveys of NSSO's, i.e., 52 nd round and 60 th round which were collected in 1995-1996 and 2004. Some research has been carried out to examine ailing and hospitalization, but, they were only village level/district level or state level studies. Studies on ailing and hospitalization for all India are few. There are a number of factors that influence ailing and hospitalization such as demographic (age, sex, and residence), social (religion, social group, and marital status), household (structure, source of drinking water, water treatment, and availability of latrine, drainage facility, and source of energy for cooking), and economic (education, activity status, and landholding). Multivariate analyses were used for examining the relationships. The overall odds ratio of logistic regression shows that the Hindus, never married people have higher chance of ailing and hospitalization in India. As expected young males residing in urban areas have lower chance of ailing and hospitalization. Southern and western people of India were more likely to be ailing and hospitalized than persons in other parts of India.
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Inducible clindamycin resistance in staphylococcus isolates from a tertiary care hospital in Eastern India
Simit Kumar, Maitreyi Bandyopadhyay, Kumkum Bhattacharya, Manas Kumar Bandyopadhyay, Parthajit Banerjee, Nupur Pal, Soma Mondal, Tapashi Ghosh
September-October 2012, 5(5):468-470
DOI:10.4103/1755-6783.105134  
Purpose: The increasing resistance to antimicrobial agents among Staphylococci has led to renewed interest in the usage of macrolide-lincosamide-streptogramin B (MLS B ) antibiotics to treat Staphylococcus aureus (S. aureus) infections. The resistance to macrolide can be mediated by msr A gene coding for the efflux mechanism or via erm gene encoding for enzymes that confer inducible or constitutive resistance to MLS B antibiotics. In vitro routine tests for clindamycin susceptibility may fail to detect inducible clindamycin resistance due to erm genes resulting in treatment failure, thus necessitating the need to detect such resistance by a simple D test on a routine basis. Materials and Methods: One hundred and ninety-five S. aureus isolates were subjected to routine antibiotic susceptibility testing including cefoxitin (30 μg) by a modified Kirby Bauer disk diffusion method. Inducible resistance to clindamycin in S. aureus was tested by the "D test" as per CLSI guidelines. Results: Thirty-three (16.9%) isolates showed inducible clindamycin resistance, 45 (23%) showed a constitutive resistance while remaining 33 (16.9%) showed the MS phenotype. Inducible resistance and constitutive resistance were found to be higher in MRSA compared to MSSA (22.6%, 35.5%, and 11.8%, 11.8%, respectively). Conclusion: Clindamycin is kept as a reserve drug and is usually advocated in severe MRSA infections depending upon the antimicrobial susceptibility results. This study showed that a D test should be used as a mandatory method in routine disk diffusion testing to detect inducible clindamycin resistance in Staphylococci for the optimum treatment of patients.
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