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Non-steroidal anti-inflammatory drugs (NSAIDs) (aspirin, ibuprofen, naproxen, ketoprofen, and diclo�fenac) were determined in three selected wastewater treatment plants (WWTPs) in southwestern India and the Gurupura River. The concentrations of the NSAIDs in the influents of the WWTPs ranged 125 e184 mg/L for aspirin, 5e22 mg/L for ibuprofen, 11e217 mg/L for naproxen, 3e41 mg/L for ketoprofen and 12e68 mg/L for diclofenac. In the effluents, concentrations ranged 0.4e0.7 mg/L for aspirin, 0.1e2 mg/L for ibuprofen, 3e14 mg/L for naproxen, 0.6e0.8 mg/L for ketoprofen and 2e26 mg/L for diclofenac. The NSAIDs in the WWTPs were found in the order of aspirin > naproxen > diclofenac > ketoprofen > ibuprofen. In the Gurupura river, aspirin (0.02 mg/L), ibuprofen (0.17 mg/L), naproxen (8.8 mg/L), ketoprofen (1.5 mg/L) and diclofenac (1.6 mg/L) were quantified. Hazard quotient (HQ) for various aquatic organisms were calculated for the effluents of WWTPs and Gurupura river water. The results showed medium risk of ibuprofen and naproxen to polyp Hydra attenuata. Continuous discharge of NSAIDs into the river can result in adverse effects to the resident organisms

Introduction: Melioidosis, caused by the soil saprophyte B. pseudomallei, is a ‘neglected’ infectious disease in many Asian countries. It remained undiagnosed or misdiagnosed in India for long due to a lack of awareness and facilities to diagnose the disease; however, it is slowly gaining the status of an emerging disease recently. The disease is well known as a great mimicker, as the presentations are very similar to many other tropical diseases, and more importantly, to tuberculosis . Methodology: A prospective observational study was conducted from January 2016 – December 2018 to find the occurance of melioidosis in patients with ‘recurrent’ tuberculosis infection in a tertiary health care hospital from southern India. All suspected cases of recurrent tuberculosis were simultaneously tested for the presence of B. pseudomallei, and basic demographics and clinical details were documented. Result: Among 11,138 patients admitted with suspected tuberculosis infection, 586 (5.2%) patients were confirmed. There was recurrent Mycobacterium tuberculosis infection in 11/586 (1.8%) cases, and 7/586 (1.2%) had growth of B. pseudomallei in culture. Patients with melioidosis had either pulmonary involvement, or bone and joint infections and deep abscesses. Uncontrolled diabetes mellitus was the major risk factor. Conclusion: The study foreshadows the need for prompt and accurate microbiological diagnosis along with a high index of suspicion from the clinicians in countries which are endemic for both melioidosis and tuberculosis, thus ameliorating the irrational anti-tuberculosis treatment.

Antibiotics received by sewage treatment plants may be the causative factor in spreading antibiotic resistance bacteria in the aquatic environment. The current study investigates the distribution of antimicrobial-resistant Escherichia coli (E. coli) in four sewage treatment plants (STPs) in South India receiving hospital and domestic wastewater in different proportions. A total of 221 E. coli isolates were checked for antimicrobial resistance against 16 antimicrobials. Among the antimicrobials tested, ampicillin (AMP) and cefazolin (CFZ) showed resistance between 20% and 90%, nalidixic acid (NAL) and ciprofloxacin (CIP) showed resistance between 15% and 75% and chloramphenicol (CHL) showed resistance between 2% and 20%. Based on the observations, there is no significant difference between the wastewater inlet and outlet, suggesting that treatment process was not effective in reducing the resistance. In conclusion, the trends of antimicrobial resistance pattern show that the levels of resistance were slightly higher in hospital wastewater than domestic wastewater.This article has been made Open Access thanks to the generous support of a global network of libraries as part of the Knowledge Unlatched Select initiative.

Summary Background In low- and middle-income countries (LMICs), the burden of healthcare-associated infections (HCAIs) is not known due to a lack of national surveillance systems, standardized infection definitions, and paucity of infection prevention and control (IPC) organizations and legal infrastructure. Aim To determine the status of IPC bundle practice and the most frequent interventional variables in LMICs. Methods A questionnaire was emailed to Infectious Diseases International Research Initiative (ID-IRI) Group Members and dedicated IPC doctors working in LMICs to examine self-reported practices/policies regarding IPC bundles. Responding country incomes were classified by World Bank definitions into low, middle, and high. Comparison of LMIC results was then made to a control group of high-income countries (HICs). Findings This survey reports practices from one low-income country (LIC), 16 middle-income countries (MICs) (13 European), compared to eight high-income countries (HICs). Eighteen (95%) MICs had an IPC committee in their hospital, 12 (63.2%) had an annual agreed programme and produced an HCAI report. Annual agreed programmes (87.5% vs 63.2%, respectively) and an annual HCAI report (75.0% vs 63.2%, respectively) were more common in HICs than MICs. All HICs had at least one invasive device-related surveillance programme. Seven (37%) MICs had no invasive device-related surveillance programme, six (32%) had no ventilator-associated pneumonia prevention bundles, seven (37%) had no catheter-associated urinary tract infection prevention bundles, and five (27%) had no central line-associated bloodstream infection prevention bundles. Conclusion LMICs need to develop their own bundles with low-cost and high-level-of-evidence variables adapted to the limited resources, with further validation in reducing infection rates.

Aims In this present study, the utility of a newly developed loop-mediated isothermal amplification (LAMP) and real-time PCR assays designed to amplify the virB gene region of Brucella melitensis was evaluated from human clinical specimens. Methods and results Fifty-four culture-confirmed cases of brucellosis and 54 culture negative but clinically suspected cases of brucellosis were included in the study. Whole blood, serum and other nonblood specimens were collected and subjected to blood culture using automatic blood culture system, serological tests, LAMP assay and real-time PCR. Overall sensitivities of LAMP and real-time PCR assays were 67·5 and 68·3% respectively. For nonblood clinical specimens, we noticed a marked increase in the sensitivities of LAMP (88·9%) and real-time PCR (100%) assays. Conclusions Performance of LAMP and real-time PCR was not satisfactory for whole-blood specimens because of the low abundance of bacteria or DNA. On the other hand, using nonblood specimens, both the assays showed higher sensitivity and specificity which makes them a good alternative for the rapid diagnosis of human brucellosis. Significance and impact of the study The developed LAMP and real-time PCR assays are a specific and rapid diagnostic tool for direct and early detection of Brucella in clinical specimens.

The aim of our study was to examine and compare the clinical presentations, complications, laboratory findings, treatment and outcome of patients with acute, subacute and chronic forms of brucellosis in a tertiary care setting. This hospital-based observational study was undertaken between April 2015 and March 2017. Patients diagnosed with brucellosis, either by blood culture and/or serology, were recruited. A total of 94 cases of brucellosis of acute, subacute and chronic forms were observed in 78.7%, 15.9% and 5.3%, respectively. Blood culture grew Brucella spp. in 70.2% cases. Serological tests showed positivity in 96.8% of the patients. Using multivariate logistic regression analysis, fever and upper back pain were significant predictors for both acute and chronic forms of the disease, respectively. There is a need to increase awareness and understand the local sero-epidemiological pattern of brucellosis as it is still little known.

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Summary We present the first two fulminant cases of pulmonary melioidosis in febrile neutropenic patients with acute and varied presentations seen in our institution and their fatal outcome. A high index of suspicion coupled with microbiological confirmation can facilitate the administration of the appropriate therapy in cases of melioidosis that differ from other bacterial infections in terms of presentation and the response to antimicrobials.