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ObjectiveTo evaluate pertussis antibody status of pregnant women and their newborns, and the impact of antenatal immunisation.DesignObservational study.SettingHospitals in urban western India.ParticipantsPregnant women and their newborns.MethodsPertussis antibody titres in mothers and their newborns were determined. Vaccinated and unvaccinated mothers and their newborns were compared for baseline characteristics, geometric mean titres (GMTs) and placental transfer ratio of antibodies. Multivariate logistic regression was performed to understand the influence of different factors on protective antibody titres.ResultsOf 284 mother–infant pairs, 75 mothers and 73 of their newborns were seropositive for anti-pertussis toxin (PT) IgG antibodies. 94 women were vaccinated in pregnancy; 51 (54.3%) of these mothers and newborns were PT IgG positive, compared with 24 (12.3%) of the women (and 22 newborns) not vaccinated in pregnancy. Women vaccinated in pregnancy and their newborns had higher GMT (30.88 and 32.54 IU/mL), compared with women who were not vaccinated (12.63%, 2.24 IU/mL) and their newborns (11.58%, 2.53 IU/mL). Placental transfer ratios in newborns of mothers vaccinated in pregnancy and those who had childhood immunisation or natural immunity were similar (1.05 and 1.12, respectively). Protective titres of antibodies at birth (>20 IU/mL) were observed in 72.3% vs 21% of newborns of vaccinated and unvaccinated pregnant women, respectively; influenced by mother’s vaccination status and seropositivity.ConclusionProtection against pertussis is low in newborns of mothers who are only immunised during childhood. Vaccination early in pregnancy boosts maternal and neonatal immunity.

Alappuzha coastal district was worst affected by floods due to the heavy rainfall in August 2018. Aedes albopictus survey carried out in the post flood/ disaster areas covering 1,140 households revealed maximum larval positivity in plastic/leather followed by metal and earthen containers. The House index ranged from 1.75 to 12.28 per cent whereas the container index ranged from 1.73 to 20.51 per cent. Breteau index ranged from 3.5 to14.3. As dengue is endemic in the district, there exists a potential outbreak of the vector borne disease.

Enzyme linked immunosorbent assay (ELISA) for antibody identification, is important for laboratory confirmation of rubella infection in different settings. The Enzygnost rubella ELISA, widely used in the World Health Organization (WHO) Global Measles and Rubella Laboratory Network, is expensive and often unavailable. Qualitative and quantitative performance of the Euroimmun ELISA was compared with the Enzygnost ELISA, for detection of rubella specific IgM, using 283 sera collected from suspected congenital rubella syndrome (CRS) patients and IgG antibodies using 435 sera from a serosurvey among pregnant women. Good qualitative agreement was observed for detection of both rubella specific IgM (94.7% agreement and κ of 0.86) and IgG (96.3% agreement and κ of 0.84). Bland-Altman analysis for IgG yielded a mean difference of 0.781 IU/ml with 97.1% values within ±2 SD of the mean difference. Our study findings suggest that Euroimmun ELISA may be considered for detection of rubella specific IgM in suspected CRS cases and rubella specific IgG in surveillance studies.

Background & objectives: Kyasanur forest disease (KFD) is an infectious disease discovered in Karnataka State of India in 1957; since then, the State has been known to be enzootic for KFD. In the last few years, its presence was observed in the adjoining five States of the Western Ghats of India. The present study was conducted to understand the kinetics of viral RNA, immunoglobulin M (IgM) and IgG antibody in KFD-infected humans for developing a diagnostic algorithm for KFD. Methods: A prospective follow up study was performed among KFD patients in Sindhudurg district of Maharashtra State, India. A total of 1046 suspected patients were tested, and 72 KFD patients were enrolled and followed for 17 months (January 2016 to May 2017). Serum samples of KFD patients were screened for viral RNA, and IgM and IgG antibodies. Results: KFD viral positivity was observed from 1st to 18th post-onset day (POD). Positivity of anti-KFD virus (KFDV) IgM antibodies was detected from 4th till 122nd POD and anti-KFDV IgG antibodies detected from 5th till 474th POD. A prediction probability was determined from statistical analysis using the generalized additive model in R-software to support the laboratory findings regarding viral kinetics. Interpretation & conclusions: This study demonstrated the presence of KFD viral RNA till 18th POD, IgM antibodies till 122nd POD and IgG till the last sample collected. Based on our study an algorithm was recommended for accurate laboratory diagnosis of KFDV infection. A sample collected between 1 and 3 POD can be tested using KFDV real-time reverse transcriptase polymerase chain reaction (RT-PCR); between 4 and 24 POD, the combination of real-time RT-PCR and anti-KFDV IgM enzyme-linked immunosorbent assay (ELISA) tests can be used; between POD 25 and 132, anti-KFDV IgM and IgG ELISA are recommended.

Non-fermenting gram-negative bacilli (NFGNB) are an emerging problem in neonatal sepsis. A major concern is multi-drug resistance which severely limits treatment options.A retrospective observational study was conducted to analyse the role of non-fermenters in neonatal sepsis over a 4-year period, the factors leading to this trend and the pattern of antibiotic resistance.Demographic and clinical data were collected for all neonates with blood culture-positive sepsis during the study period, January 2007 to December 2010.Blood cultures were positive in 186 (13%) of 1402 neonates, in 44 (32.1%) of whom the cause was NFGNB. Acinetobacter spp was the most common organism (n = 30). Infection by NFGNB showed a steady increase (P0.0001), and was fairly evenly distributed between early- and late-onset sepsis. The infection rate was significantly higher in inborn neonates (P = 0.04) and those delivered vaginally (P = 0.002). Multi-drug resistance (MDR) occurred in 50% and carbapenem resistance in 30% of Acinetobacter spp isolates. In five cases there was panresistance of Acinetobacter spp to all antibiotics tested.The trend of increasing numbers of cases of NFGNB in neonatal sepsis compounded by MDR is of great concern. It is necessary to administer antibiotics judiciously, strengthen surveillance and laboratory services in neonatal intensive care units, and re-evaluate treatment guidelines for management of infection by these organisms.

Sepsis is an important cause of morbidity and mortality among neonates. Enteric Gram-negative bacteria and Staphylococcus aureus are common causes of neonatal sepsis in the developing world. We report a case of neonatal sepsis caused by Brevundimonas vesicularis. To the best of our knowledge, this is the first case report of invasive B. vescularis infection in a newborn in the English literature.

To investigate the trend of tigecycline susceptibility and mechanisms behind tigecycline non-susceptibility in Klebsiella pneumoniae and Escherichia coli isolates causing neonatal septicaemia (2007-10).MICs of tigecycline for the isolates were determined. The isolates were evaluated for β-lactamases and carbapenemases. Molecular typing of the tigecycline-resistant isolates was performed. Expression of efflux pump genes (acrA, acrB and tolC) and regulators (soxS and ramA) was examined by real-time RT-PCR and western blotting. Sequencing of the ramA and ramR genes was carried out to identify mutations within these genes.Tigecycline susceptibility was evaluated in all K. pneumoniae (n = 57) and E. coli (n = 19) blood isolates. The prevalence of extended-spectrum β-lactamase (ESBL)-producing organisms was high, but tigecycline non-susceptibility remained low in these isolates. Though MIC values of tigecycline remained in the susceptible range, there was a 2-fold increase in the value of MIC90 from 2007 to 2010. Over the 4 year period K. pneumoniae showed higher MIC values of tigecycline in comparison with E. coli. Tigecycline non-susceptibility was not observed among carbapenem-resistant isolates. Only two ESBL-producing clonally distinct K. pneumoniae isolates showed tigecycline resistance with overexpression of ramA and the AcrAB-TolC pump. No mutations were present within the ramA and ramR genes that might enhance the expression of the pump.The study showed for the first time the trend of tigecycline susceptibility in E. coli and K. pneumoniae causing neonatal septicaemia. Tigecycline still has potent antimicrobial effects against most ESBL- or carbapenemase-producing K. pneumoniae and E. coli, but the increasing MIC values make it essential to be vigilant.

Carbapenem-resistant determinants and their surrounding genetic structure were studied in Acinetobacter spp. from neonatal sepsis cases collected over 7 years at a tertiary care hospital. Acinetobacter spp. (n = 68) were identified by ARDRA followed by susceptibility tests. Oxacillinases, metallo-β-lactamases (MBLs), extended-spectrum β-lactamases and AmpCs, were detected phenotypically and/or by PCR followed by DNA sequencing. Transconjugants possessing the bla NDM-1(New Delhi metallo-β-lactamase) underwent further analysis for plasmids, integrons and associated genes. Genetic environment of the carbapenemases were studied by PCR mapping and DNA sequencing. Multivariate logistic regression was used to identify risk factors for sepsis caused by NDM-1-harboring organisms. A. baumannii (72%) was the predominant species followed by A. calcoaceticus (10%), A. lwoffii (6%), A. nosocomialis (3%), A. junni (3%), A. variabilis (3%), A. haemolyticus (2%), and 14TU (2%). Fifty six percent of the isolates were meropenem-resistant. Oxacillinases present were OXA-23-like, OXA-58-like and OXA-51-like, predominately in A. baumannii. NDM-1 was the dominant MBL (22%) across different Acinetobacter spp. Isolates harboring NDM-1 also possessed bla (VIM-2, PER-1, VEB-2, CTX-M-15), armA, aac(6')Ib, aac(6')Ib-cr genes. bla NDM-1was organized in a composite transposon between two copies of ISAba125 in the isolates irrespective of the species. Further, OXA-23-like gene and OXA-58-like genes were linked with ISAba1 and ISAba3 respectively. Isolates were clonally diverse. Integrons were variable in sequence but not associated with carbapenem resistance. Most commonly found genes in the 5' and 3'conserved segment were aminoglycoside resistance genes (aadB, aadA2, aac4'), non-enzymatic chloramphenicol resistance gene (cmlA1g) and ADP-ribosylation genes (arr2, arr3). Outborn neonates had a significantly higher incidence of sepsis due to NDM-1 harboring isolates than their inborn counterparts. This study demonstrates the significance of both A. baumannii and other species of Acinetobacter in cases of neonatal sepsis over an extended period. Oxacillinases and bla NDM-1 are the major contributors to carbapenem resistance. The dissemination of the bla NDM-1 is likely linked to Tn125 in diverse clones of the isolates.

Objective To study the organisms causing early and late onset neonatal sepsis, with special reference to multi-drug resistant gram negative bacilli, at two neonatal units (one urban, one rural) in India. Methods Prospective surveillance study. Results There were 159 episodes of sepsis (81 urban and 77 rural) affecting 158 babies. Gram negative bacilli caused 117 infections (68%) and predominated at both centres in both early and late sepsis. Klebsiella pneumoniae was the commonest organism, causing 61 infections (38.3%). In early sepsis (0–2 days), non-fermenting gram negative bacilli caused 42.1% of infections at the urban centre; there were no cases of early Group B Streptococcus sepsis. Late onset sepsis was mainly caused by gram negative bacilli at both centres. Multi-drug resistance of over 80% of early-onset gram negative organisms to ampicillin, third generation cephalosporins and gentamicin indicates that these multi-resistant organisms are almost certainly circulating widely in the community. The overall mortality from early sepsis was 27.3% (9 of 33) and from late sepsis was 26.2% (33 of 126). Gram negative bacilli caused all deaths from early sepsis and 87.5% of deaths from late sepsis. Conclusion This study shows that multi-drug resistant gram negative bacilli are a major cause of early and late neonatal sepsis in India and are almost certainly widespread in the community.

Stenotrophomonas maltophilia, a multi drug resistant non fermenting Gram negative bacillus is an increasingly common nosocomial pathogen, especially in intensive care units. Comparatively few cases of infection have been reported in neonatal population. We present two cases of early onset neonatal sepsis due to S.maltophilia and a brief review of documented isolation in neonates.

Neonatal sepsis due to carbapenem-resistant bacteria is difficult to treat due to limited therapeutic options. The detection of the new carbapenemase New Delhi metallo-β-lactamase-1 (NDM-1) from neonates has further complicated the situation (Roy et al., 2011a). The potent metallo-β-lactamase NDM-1 efficiently hydrolyses all classes of β-lactam antibiotics (penicillins, cephalosporins and carbapenems) and is also associated with multiple determinants that enable the bacteria to become resistant to other antibiotic classes (Nordmann et al., 2011). In the presence of NDM-1 other β-lactamases may go unobserved because of the spectrum of activity of NDM-1 against all β-lactam antibiotics. Thus, under the canopy of the NDM-1 these β-lactamases also get the opportunity to spread. This communication reports association of two novel β-lactamases, SHV-type β-lactamase (SHV-167) and AmpC-type β-lactamase (ACT-16), in two NDM-1-carrying Enterobacteriaceae isolated from the blood of two septicaemic neonates admitted to a neonatal intensive care unit.

Infections caused by Acinetobacter baumannii are a threat to neonates because of its resistance to antimicrobials, including carbapenems. In 2007, A. baumannii emerged as an important aerobic Gram-negative bacillus (12.5%, 4/32) that caused sepsis in our unit. A. baumannii from the gut of the neonates was analyzed, as this could be indicative of the antibiotic resistance of the organisms. The study attempts to understand the gut colonization with multidrug-resistant A. baumannii among hospitalized neonates with special reference to carbapenem resistance. A. baumannii was found in the gut of 11% of babies. Interestingly, 60.7% (17/28) and 21.4% (6/28) of the isolates from the gut were multidrug-resistant and carbapenem-resistant, respectively. The number of multidrug-resistant and carbapenem-resistant isolates from blood cultures were 3/4 and 1/4, respectively. The study reports for the first time OXA-23 and OXA-58 carbapenemases in A. baumannii from India. Pulsed field gel electrophoresis (PFGE) patterns indicated that the strains were diverse and no epidemic clone existed. Though A. baumannii gut colonization could not be implicated as a risk factor for subsequent sepsis, the high rate of isolation of multidrug-resistant and carbapenem-resistant isolates indicates that these therapeutic options might be drastically reduced among neonates in the future.

The various thermal properties, viz., specific heat, thermal conductivity and thermal diffusivity were determined for both the grains and flours of foxtail millet (Sestaria italia), little millet (Panicum miliare), poroso millet (Panicum miliaceum), kodo millet (Paspalum sorobiculatum), finger millet (Eleusine coracana) and barnyard millet (Echinochola colona) in the moisture content range of 10–30%. Specific heat was determined using the method of mixtures and the transient heat flow method, and a thermal diffusivity probe was used for the determination of thermal conductivity and thermal diffusivity of the millets and their flours. An increase in specific heat was observed in the range of 1·33– 2·40 kJ kg −1 K −1 for both grains and flours, with an increase in moisture content. The thermal conductivity of the millet grains increased from 0·119– 0·223 W m −1 K −1 and the flours increased from 0·026– 0·128 W m −1 K −1 in the moisture range of 10–30%. The thermal conductivity of flour was considerably less than that of grains. As the moisture content increased from 10 to 30% (wb), thermal diffusivity of millet grains decreased from 0·731×10−3 to 0·55×10 −3 m 2 h −1 and that of their flours ranged from 0·820×10−3 to 0·592×10 −3 m 2 h −1 . Notation A constant D thermal diffusivity, m 2 h −1 H c heat capacity of the calorimeter, kJ K −1 H ca heat capacity of the capsule, kJ K −1 Q heat input, W R inner radius of the cylinder, m S specific heat of sample, kJ kg −1 K −1 S w specific heat of water, kJ kg −1 K −1 T 1 temperature at time θ 1 , K T 2 temperature at time θ 2 , K T cp temperature at the centre of the thermal diffusivity probe, K T e equilibrium temperature of the mixture in the calorimeter, K T s temperature of the sample, K T sp temperature at the outer surface of the thermal diffusivity probe, K T w initial temperature of water in the calorimeter, K W s mass of sample, kg W w mass of water in the calorimeter, kg θ 0 time correction factor, s θ 1 time corresponding to temperature T 1 , s θ 2 time corresponding to temperature T 2 , s

This study reports a cluster of septicaemic newborns with imipenem-resistant Escherichia coli in the blood and delineates the possible mechanisms of transmission of imipenem resistance with respect to the New Delhi metallo-β-lactamase (NDM-1) gene.During a point prevalence survey, attempts were made to isolate Gram-negative bacilli (GNB) from the environment of a sick newborn care unit (SNCU) and body sites of neonates. Subsequently, four fresh neonates admitted to the SNCU developed sepsis with E. coli. E. coli isolates from body sites and blood of the newborns were analysed in terms of clonality, carbapenemases, integrons, virulence factors, porins and transmissibility.During the survey, both imipenem-resistant and imipenem-susceptible E. coli were isolated from the body sites of neonates, but none from the environment. None of these neonates developed sepsis. The freshly admitted septicaemic neonates had imipenem-resistant E. coli in their blood, which were similar to the imipenem-susceptible E. coli obtained from the body sites (during the survey) in terms of clonality, phylogroup, virulence and other resistance genes, except possession of bla(NDM-1). Imipenem-resistant E. coli from blood and body sites were not clonal, though both had bla(NDM-1). Besides E. coli, other GNB isolated from the environment and body sites also harboured bla(NDM-1). Imipenem-resistant and imipenem-susceptible E. coli from the blood and body sites respectively, possessed a novel AmpC β-lactamase, bla(CMY-59). The plasmid carrying bla(NDM-1) was transferable.The time frame of isolation and clonal identity indicated a possible transfer of bla(NDM-1) from imipenem-resistant GNB to the imipenem-susceptible E. coli, which subsequently caused septicaemia. This establishes the promiscuous nature of bla(NDM-1) and emphasizes the need for the early recognition of similar isolates.

SUMMARYNewborns often present with skin conditions ranging from transient benign to severe. An occasional cause of neonatal exanthemic rash is infection due to Gram-positive bacteria, but Gram-negative infection is uncommon. We describe an outbreak of sepsis in 10 neonates over a 2-week period, caused by Klebsiella pneumoniae in a level III neonatal intensive care unit (NICU). Seven babies developed an exanthematous maculopapular rash. Molecular analysis by pulsed-field gel electrophoresis showed that all the babies with rash were infected by a single strain of K. pneumoniae which was distinct from the strain recovered from babies without rash.

Occurrence of sugarcane yellow leaf syndrome (SCYLV) has been reported from four states (U.P., Haryana, Maharashtra, Tamil Nadu) of India. The association of SCYLV was confirmed by DAC-ELISA test using polyclonal antiserum. This is the first report of the occurrence of sugarcane yellow leaf virus in India.