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Background & objectives: Owing to the ever-expanding access to HAART (highly active anti-retroviral therapy) in resource-limited settings, there is a need to evaluate alternate markers like absolute lymphocyte count (ALC) as a surrogate for CD4 counts. This study was done to assess the usefulness of ALC as a surrogate marker for CD4 counts in monitoring HIV-infected patients after HAART initiation. Methods: In this study, 108 HIV-positive adult patients of both sexes fulfilling the inclusion criteria were included. CD4 and ALC were recorded at baseline. After initiation on HAART, these patients were followed up at three month intervals. Results: ALC and CD4 counts were positively correlated (Spearman correlation coefficient= 0.553). After six months of HAART, the sensitivity of an ALC increase as a marker for CD4 count increase at six months was 82 per cent, specificity was 100 per cent, PPV was 100 per cent and NPV was 31 per cent. Area under the corresponding ROC curve for CD4 increase of >100 cells/μl was 0. 825 ± 0.053. Interpretation & conclusions: ALC may be a useful surrogate marker in predicting an increase in CD4 counts as a response to HAART, but of questionable value in predicting a decrease in CD4 counts.

Methods The study group included 106 HIV positive patients with history of heterosexual contact and the control group included 30 asymptomatic healthy individuals. The sera of patients were tested for HBsAg and antiHCV using third generation ELISA kits. The samples positive for first kit were retested for confirmation of results. The sera of control group were simultaneously screened for HIV, HBsAg, and anti-HCV by ELISA method.

Background: The one-year survival rate of adults with the Acquired Immunodeficiency Syndrome (AIDS) after Anti Retroviral Therapy (ART) initiation and data on the efficacy of generic ART has not been well documented in India. The other objective was to see if opportunistic Infections were a significant risk factor for mortality. Methodology: Survival was studied in a prospective observational cohort study of 108 ART-naive patients with AIDS in a South Indian state by Kaplan Meier estimates. Efficacy of different generic ART regimens was evaluated by Cox-regression analysis and multiple logistic regression analysis was performed to assess the role of opportunistic infections in mortality. Results: The overall survival rate was 94.25% at 6 months and 88.46% at one year after ART initiation among persons who initiated therapy with CD4 counts < 200 cells/ cu.mm. There was no difference in survival between those on Efavirenz-based or nevirapine-based regimens. The mortality rate at the end of one year was 9% (nine deaths), out of which four deaths occurred within the first 90 days of ART initiation. Pulmonary Tuberculosis was a significant risk factor for mortality (OR = 4.768, p ≤ 0.05). Conclusion: Generic ART is beneficial in a majority of AIDS patients in resource-limited settings. Pulmonary Tuberculosis is an important risk factor for mortality in AIDS patients on ART.

Introduction: In resource-limited settings, due to the high cost of CD4 cell count testing, physicians must decide about opportunistic infection (OI) prophylaxis without a laboratory evaluation of HIV stage and level of immune suppression. This study aimed to evaluate the correlation of total lymphocyte count (TLC), an inexpensive laboratory parameter, to CD4 count, and to determine a range of TLC cut-offs for the initiation of OI prophylaxis that is appropriate for resource-limited settings. Methodology: Spearman correlation between CD4 count and TLC was assessed in patients attending the Anti-Retroviral Therapy (ART) centre at Mysore, India. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of various TLC cut-offs were computed for CD4 counts < 200 cells/mm3. Correlation and statistical indices were computed for all patients and for HIV patients with active tuberculosis. Results: Good correlation was noted between the 106 paired TLC and CD4 counts (r = 0.3497).TLC < 1200cells/mm3 had 88.14% sensitivity and 34.78% specificity for CD4 count < 200 cells/mm3. In those patients with active tuberculosis, TLC< 2000cells/mm3 had 95.24% sensitivity and 100% specificity for CD4 count < 200cells/ mm3. Conclusions: TLC could serve as a low-cost tool for determining when to initiate prophylaxis in resource-constrained settings.

DNA samples from 19 reference serovars belonging to 19 different serogroups of Leptospira interrogans and two serovars belonging to Leptospira biflexa were examined by bacterial restriction endonuclease analysis using EcoR I and Hae III enzymes. All the serovars gave unique restriction patterns that differed from each other. DNA from 10 local isolates digested with these enzymes produced patterns which on comparison with the standard patterns produced by reference strains could be identified to serovar level.

Background: Cardiovascular disease, resulting from atherosclerosis, is a leading cause of global morbidity and mortality. Classical risk factors explain much of the attributable risk for cardiovascular events, but other risk factors for the development and progression of atherosclerosis, which can be identified, may be important therapeutic targets. Infectious agents, such as Chlamydia pneumoniae, have been proposed as contributory factors in the pathogenesis of atherosclerosis. The present study was conducted to determine the seroprevalence of C. pneumoniae antibodies and to study the association of chronic C. pneumoniae infection with Coronary Artery Disease (CAD). Methods: The study group included 90 angiographically proven CAD patients and age and sex matched 90 normal coronaries as control group. With total aseptic precaution 3 ml blood was collected. Enzyme linked immunosorbant assay was performed for all subjects to detect the presence of IgG and IgA antibodies to Chlamydia pneumoniae (Cp). Results: IgG and IgA Cp antibodies were detected in 67.8% and 58.9% CAD patients compared to 45.6% and 11.1% controls. IgG + IgA Cp antibodies were detected in 88.9% CAD patients when compared to 50.0% controls. Seroprevalence of IgG and IgA Cp antibodies were high among CAD patients compared to controls and was found statistically significant. A significant presence of Chlamydia pneumoniae antibodies was detected in smokers, diabetes mellitus, hypertension, and dyslipidemia. Conclusion: In the present study, the seroprevalence of IgG and IgA Cp antibodies was found to be higher in CAD patients compared to controls. The present study supports the association between Chlamydia pneumoniae infection and Coronary artery disease.

Background: The global impact of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection is one of the major public health challenge. India has a very high burden of TB according to the WHO. A decrease in CD4 counts in HIV-TB co-infection leads to an increase in morbidity and mortality. Methods: Information regarding the duration of HIV, type of TB, CD4 counts before and after ATT and any associated Opportunistic Infections (OIs) were collected from the records of 100 patients with HIV-TB co-infection who attended ART centre for a period of one year. The collected data was statistically analyzed. Results: In the study group, 35 had Pulmonary Tuberculosis (PTB) and 65 had Extra Pulmonary Tuberculosis (EPTB), 40 had OIs. Mean CD4 count prior to ATT in PTB was 197 (7-940), EPTB 192 (13-683) and with OIs 129 (7-288). After completion in PTB was 300, EPTB 302 and 252 in OIs. Least CD4 count of 121 was observed in patients above 50yrs and after completion it was 133. Incidence of both EPTB and PTB was higher in males 66.2% and 62.9%, and in the age group of 31-50 yrs 50.8% and 60% (Cell counts expressed in cells/µl.). Conclusion: In our study, we found that there was significant recovery of CD4 cells following ATT. Difference in CD4 counts among patients with PTB and EPTB was not significant. There was remarkable reduction of CD4 counts in patients who had other OIs and the recovery after ATT was also marginal.

MALIGNANT catarrhal fever (MCF) is a fatal disease of wild and domestic ruminants, with severe and widespread inflammatory and degenerative changes in affected animals. It typically has a short, dramatic clinical course, characterised primarily by high fever, severe depression, swollen lymph nodes, salivation, diarrhoea, dermatitis, neurologic disorders and ocular lesions often leading to blindness (Plowright and others 1990). MCF is increasingly being recognised as the cause of significant economic losses in several …

Background and Objective: Diabetic foot ulceration is a multifactorial process involving various intrinsic complications of diabetes mellitus which cause injury to the foot at risk. The diabetic foot ulcer infections are polymicrobial in nature. Failure to recognize and control of the infectious process may have devastating consequences of limb amputation, sepsis, and mortality. Hence, the study was undertaken to determine the bacterial and clinical profile of diabetic foot ulcer using optimal culture techniques and the antimicrobial sensitivity pattern of the isolates. Materials and Methods: A total of 100 patients with diabetic foot ulcer of Wagner's grade I and above were included in the study. Pus and tissue biopsy were collected for bacteriological study. The specimen was processed in the microbiology laboratory for Gram stain, aerobic culture, and anaerobic culture. The organisms isolated were identified by standard procedures and antimicrobial susceptibility was done by Kirby-Bauer disc diffusion method. Results: A total of 187 organisms were isolated, with an average of 1.87 organisms per specimen. Pseudomonas sp, 36 (21.9%), was the most common aerobic organisms isolated followed by Klebsiella sp, 32 (19.4%). Anaerobic organisms isolated were 22 (11.77%). The predominant anaerobic organisms isolated were Peptostreptococcus sp, 10 (45.5%). All the aerobic Gram-negative organisms were sensitive to imipenem (100%). Gram-positive organism was 100% sensitive to vancomycin. Methicillin resistant staphylococcus aureus (MRSA) was seen in 66.7%. All the anaerobes were sensitive to metronidazole, clindamycin, cefoxitin, and penicillin G . Conclusion: Pseudomonas was the most common organism isolated in our study. MRSA was seen in 66.7% of the isolate.

Randomly amplified polymorphic DNA (RAPD) fingerprinting of 14 laboratory strains of leptospiral serovars (serovars australis, autumnalis, ballum, bataviae, canicola, grippotyphosa, hardjoprajitno, hebdomadis, icterohaemorrhagiae, javanica, pomona, pyrogenes, panama, and tarassovi) was carried out by using a pair of primers. Each serovar had a unique and distinct fingerprint pattern. DNAs of other bacterial species, including Escherichia coli, Pasteurella multocida, Salmonella spp., Pseudomonas spp., and Klebsiella spp., did not show any amplification. RAPD fingerprinting was found to be a rapid and sensitive method for serovar identification when it was compared to DNA restriction enzyme analysis, which produced a larger number of bands that made it more difficult to compare serovars.