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Intestinal parasitic infections (IPIs) are one of the major causes of morbidity in the developing world. This hospital-based prospective study was undertaken to estimate the prevalence rates of IPIs and to assess the risk factors associated with these infections in children attending a paediatric hospital. Seven hundred and five patients were analysed for IPIs and associated risk factors from April 2018 to March 2019. Information on the associated risk factors was obtained from a structured questionnaire protocol. Microscopic examination of stool samples was done by direct slide smear and after the formol-ether concentration technique. The overall prevalence of IPIs was 20.9%. In the age group, 5-9 years, the prevalence of parasitic infection (27.4%) was high. Among the intestinal parasites detected helminths and protozoans were 60.8% and 39.1% respectively. Among the helminths, Ascaris lumbricoides (20.5%) was most prevalent followed by Trichuris trichiura (18.1%) while among the protozoa Giardia intestinalis (18.7%) was most prevalent, followed by Entamoeba spp. (8.4%). Among the positive samples, the single parasite was detected in 87.8% while dual parasites were detected in 12.2% stool samples. Univariate analysis showed age, drinking water from an open well, a habit of open defecation, illiteracy and living in a rural area to be associated with a high risk of IPIs (P

BackgroundOmicron a new variant of SARS COV2 was first detected in November 2021. This was believed to be highly transmissible and evade immunity as a result urgent need was felt to screen all positive, identify Omicron cases and isolate them to prevent spread of infection and study their clinico-epidemiological profile.MethodologyAll positive cases detected in state of Rajasthan during November to January beginning were selected for next generation sequencing. Processing was done as per protocol on Ion Torrent S5 system for 1210 samples and bioinformatics analysis was done.ResultsAmong the 1210 samples tested 762(62.9%) were Delta/Delta like and other lineages, 291(24%) were Omicron and 157(12.9%) were invalid or repeat samples. Within a month the proportion of Delta and other variants was reversed, from zero omicron became 81% and delta and other variants 19%, initially all omicron cases were international travelers and their contacts but soon community transmission was seen. Majority of omicron patients were asymptomatic (56.7%) or had mild disease (33%), 9.2% had moderate symptoms and 2(0.7%) had severe disease requiring hospitalization, of which one (0.3%) died and rest (99.7%) recovered. History of vaccination was seen in 81.1%, of previous infection in 43.2%. Among the Omicron cases BA.1 (62.8%) was the predominant lineage followed by BA.2(23.7%) and B.1.529 (13.4%), however rising trends were seen initially for BA.1 and later for BA.2 also.ConclusionIn very short time Omicron has spread in community and has taken over the preexisting Delta/Delta like and other lineages, it evades immunity, but the good part is most of the cases were asymptomatic or had mild disease and mortality rate was very low.

Infections caused by extended spectrum β-lactamases (ESBL) producing gram negative bacteria complicate therapy and limit treatment options. The aim of the present study was to determine the prevalence and susceptibility of ESBL Escherichia coli (E. coli) and Klebsiella pneumoniae from various clinical isolates among hospitalized and outdoor patients at our tertiary care hospital. A total of 412 isolates from various clinical samples were screened for ESBL as per CLSI guidelines and confirmed by Phenotypic Confirmatory Disc Diffusion Test (PCDDT) and Double Disc Synergy Test (DDST). Antimicrobial susceptibility of these isolates was performed by Kirby- Bauer disc diffusion method. ESBL production was seen in 174/281(61.92%) of E. coli and 74/131(56.48%) of Klebsiella pneumoniae isolates. PCDDT detected 174(61.3 %) and 74(56.5%) of ESBL while DDST detected 164 (58.4%) and 70 (53.4%) of ESBL E. coli and Klebsiella pneumoniae respectively. ESBL producers were higher among inpatients 199/323(61.60%) compared to outpatients 49/89(55.05%). ESBL production was found to be highest among blood isolates. A high level of resistance was seen with third generation cephalosporins, piperacillin and cefepime in both ESBL E. coli and Klebsiella pneumoniae isolates. Strict adherence to the hospital antibiotic policy and good infection control practices would go a long way in curtailing the menace of drug resistance. K e y w o r d s DDST, Escherichia coli, extended spectrum β-lactamases, Klebsiella pneumoniae, PCDDT.

Background: Pseudomonas aeruginosa is emerging as a nosocomial pathogen by producing metallo-β-lactamases (MBLs) and acquiring resistance to many antimicrobial agents. The infections caused by metallo-beta-lactamases producing P. aeruginosa (MBL-PA) are associated with higher rates of mortality, morbidity, and overall healthcare costs. Aim: The aim of the study was to find the incidence of MBL in P. aeruginosa isolates and their antimicrobial resistance pattern. Material and Methods: A total of 180 non-duplicate P. aeruginosa isolates from various clinical specimens between April 2016 and March 2017 were subjected to susceptibility testing by disc diffusion test as per the Clinical and Laboratory Standards Institute guidelines 2015. Imipenem and meropenem resistant isolates were selected for the detection of MBL production by disc potentiation test and modified Hodge test. Results: Out of 180 isolates of P. aeruginosa, MBL was detected in 36 (20.00%) isolates. Resistance was significantly higher in the MBL-PA with 94.44% resistance to aztreonam followed by cefoxitin (91.66%), piperacilline/tazobactam and cefepime (80.55%). The prevalence of multidrug-resistant and possible extensively drug-resistant isolates was significantly higher among the MBL group as compared to that in the non-MBL group [50.00% vs. 11.11% and 5.55% vs. 0.69% (P =

Tuberculosis is caused by Mycobacterium tuberculosis (M.tb) as well as Non-tubercular mycobacterium (NTM) with similar clinical presentation. Infections due to NTM are reported to have increased in the past few years. Growth of M.tb is inhibited by p-Nitrobenzoic acid (PNB), whereas, NTM are resistant. One hundred and nine isolates from various clinical samples were identified up to species level by their growth rate, pigmentation, and a battery of biochemical tests, including niacin accumulation, nitrate reduction, and heat-stable catalase (68°C) reactions. Para-nitrobenzoic acid (PNB) inhibition test was performed to differentiate between M.tb and NTM. PNB was added to the Lowenstein-Jensen (LJ) medium and BACTECTM MIGIT (Mycobacteria Growth Indicator Tube)960 medium to a final concentration of 500 μg/ml. All the M.tb isolates, including Mycobacterium tuberculosis H37Rv (standard strain), were inhibited by PNB on both LJ and MGIT 960. Of the NTM isolates, all were resistant to PNB on MGIT 960 and on LJ PNB, except one isolate of Mycobacterium marinum that was resistant to MGIT 960 PNB, but was susceptible to LJ PNB. The reporting time for M.tb ranged from 4–11 days (median 5.9 days) by MGIT 960 and for NTM it was 2–10 days with an average of 4.5 days. This study was carried out to establish the accuracy and efficiency of MGIT 960 PNB and to differentiate between M.tb and NTM.

Purpose: To compare BACTEC MGIT 960 (M960) with conventional culture on Lowenstein Jensen (LJ) media and direct acid fast bacilli (AFB) smear examination for the detection of Mycobacteria in clinical samples obtained from suspected cases of pulmonary and extra pulmonary tuberculosis (TB). Methods: A total of 500 samples were processed for direct AFB smear examination, and culture on M960 and LJ media. Results: Two hundred fifty-eight out of 500 (51.6%) isolates of Mycobacteria were obtained by combined use of the two culture methods. Two hundred and fifty-three (50.6%) were positive in culture by M960 and LJ media and 28% (140/500) by direct AFB smear examination. The positivity rate of M960 system alone was 34.10% (88/258) and of LJ alone was 1.93% (5/258). Average time to detect growth (TTD) was 9.66 days by M960 and 28.81 days by LJ. Conclusions: M960 system is a rapid and sensitive method for early diagnosis of pulmonary and extrapulmonary TB. But for maximum recovery of Mycobacteria , a combination of both M960 and LJ media should be used.

Thelaziasis is an arthropod-borne disease of the eye and adnexa caused by Thelazia callipaeda, a nematode transmitted by drosophilid flies to dogs, cattle, rabbits, deers and cows. Ocular manifestations due to Thelazia in humans are rare, and there are only a few case reports. We report a case of T. callipaeda in an elderly woman belonging to a rural background. One creamy white worm was removed from the anterior chamber of the eye. We report this case for its rarity as well as to increase awareness in the medical community.

In developing countries like ours with a large number of tuberculosis (TB) cases and limited resources, the diagnosis of TB relies primarily on smear microscopy for Acid Fast Bacilli (AFB) but its sensitivity is limited in paucibacillary cases.To evaluate the increase in efficacy of smear microscopy when smears are prepared from clinical samples after concentration by Petroff's method and stained by Auramine O (AO) fluorescent dye as against Ziehl Neelsen (ZN) staining of similar taking culture as the gold standard.Smears were prepared from 393 clinical samples both by direct and after Petroff's concentration and examined by fluorescent microscopy and Ziehl Neelsen method .The concentrated material was also cultured on Lowenstein Jensen media and the results of the two microscopy methods were compared with the culture results taken as the gold standard.Mycobacterial growth was detected in 137 (35.77%) specimens, out of which three were non-tubercular mycobacteria. Using culture as the reference method, the sensitivity of direct staining was 55.55% for ZN and 71.85% for AO. Direct fluorescent microscopy detected 9.29% paucibacillary sputum samples that were missed on ZN staining. On concentration, the sensitivity increased by 6.67% for ZN and 11.11% for AO. The sensitivity of AFB smear microscopy increased by 27.41% and was statistically significant (p =.001) when both methods were combined. The specificity was 99.19% for both ZN and AO.Fluorescent microscopy has higher sensitivity and comparable specificity which is further enhanced by concentration. Now with the advent of newer inexpensive Light Emitting Diode (LED) based fluorescent microscopes (FM), which are easier to use, fluorescent microscopy can be widely used even in peripheral laboratories where culture facilities are not available.

Pyrazinamide is an important front line antimycobacterial drug, which is also being used in the treatment of multi drug resistant tuberculosis along with second line drugs in DOTS plus programme. Conventional testing of pyrazinamide on solid medium is difficult as it is active at acidic pH. Therefore, there is a need for a rapid and simple method for susceptibility testing of pyrazinamide. This study was carried out to compare pyrazinamide susceptibility testing by MGIT 960 and two rapid pyrazinamidase activity tests.Pyrazinamide susceptibility was tested in 136 clinical isolates of Mycobacterium tuberculosis by MGIT 960 and pyrazinamidase activity was tested by classical Wayne's method and modified PZase agar method.There was 88.9 per cent concordance between MGIT 960 and classical Wayne's method and 93.38 per cent with modified method for pyrazinamidase activity. Using MGIT 960 results as gold standard the sensitivity and specificity of Wayne's method was 88.15 and 90 per cent respectively and that of modified method was 89.4 and 98.3 per cent.Our study demonstrates that the modified pyrazinamidase activity test can be used as a screening test to detect resistance to pyrazinamide specially in resource limited settings but confirmation of susceptibility should be done by standard methods like MGIT 960.

Of the 191 sputum specimens that were collected from pulmonary tuberculosis patients, 78.65% (140/178) specimens were culture positive when processed within 48 h by the NaOH method. The culture positivity in the same specimen that were stored with cetylpyridinium chloride (CPC) and processed after 7-8 days was 70.22% (125/178), whereas those stored without CPC and processed by the NaOH method was 46.62% (83/178). The difference in number of positive cultures obtained before storage and after storage (without CPC) was statistically significant (P = 0.001). Culture positivity by the CPC method was comparable with that of NaOH method before storage and the difference was not statistically significant (P = 0.35).