Background: This study was undertaken to determine the prevalence of Metallo-β-lactamase (MBL) producing gram negative bacteria in a tertiary care hospital in North India. Metallo-β-lactamases are β-lactamase enzymes with distinct ability to hydrolyze and confer resistance to the carbapenems which are the commonly used drugs for the treatment of infections caused by multidrug resistant gram negative bacteria. Pathogenic bacteria producing Metallo-β-lactamases are responsible for infections in tertiary care hospitals around the world and carbapenem resistance due to these enzymes have been reported over the past few years. Material and Methods: A total of 400 Enterobacteriaceae isolates from various clinical samples were identified and tested for susceptibility to various antibiotics by disc diffusion method. MBL detection was done by combined disc diffusion test and E-test. Result: The isolates included, E.coli 170(42.50%), K. pneumoniae 113(28.25%), Citrobacter spp. 90(22.50%) & Proteus spp. 27(6.25%).Out of the 400 Enterobacteriaceae 77 were carbapenem resistant of these 77 isolates 42 (54.54%) showed an increase in zone size by the combined disc diffusion test and E-test. MBL was detected in 27(30.33%) isolates of Citrobacter spp, 26 (23.0%) K. pneumoniae, 22 (12.94%) E.coli, 2 (7.40%) Proteus spp isolates. Conclusion: The study highlights the problem of MBL mediated resistance, which indicates therapeutic challenge for the clinicians and microbiologists. Simple disc method can be routinely employed to detect these common resistance mechanisms which will reduce the mortality and also spread of such resistant strains. In view of the increasing resistance of gram negative bacilli to carbapenems, rational use of antibiotics needs to be emphasised.

BACKGROUNDTuberculosis is the leading cause of death from a curable infectious disease.[1] Examination by mycobacterial culture provides the only definitive diagnosis of tuberculosis.[3] Isolation of Mycobacteria from specimens contaminated with normal flora like sputum poses a problem in view of high nutritive value of the egg media used for mycobacterial culture. Different laboratories use different decontamination techniques. No single technique is entirely satisfactory. Hence, this study was conducted to compare the Petroff's method and NALC-NAOH (N-Acetyl-L-cysteine NaOH) method digestion decontamination procedures.MATERIALS AND METHODSThis prospective study was conducted over a period of one year (1st August 2009 to 31st July 2010) in the Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana. Samples received from various wards and intensive care units (ICUs) were processed for mycobacterial culture on 2 sets of Lowenstein-Jensen media using two decontamination procedures-Petroff's method and NALC-NaOH method.[4] The isolation rate and contamination rate of growth on both the sets of Lowenstein-Jensen media was compared.RESULTSThe contamination rate of LJ media with Petroff's method was 20.31%, while the contamination rate with NALC-NaOH method was 14.06%. In our study, the rate of isolation was similar in both the decontamination procedures. The rate of isolation was 10.93% on both the sets of LJ media.CONCLUSIONWe observed that there was no significant difference in the isolation rate of mycobacteria with the use of either Petroff's method or NALC-NaOH method, while the contamination rate was higher with Petroff's method.

BACKGROUND & OBJECTIVES: Tuberculosis has affected mankind for over 5000 years, and it still continues to be a leading cause of morbidity and mortality. As for any disease of contagious nature, early diagnosis and treatment remains the mainstay of therapy. This holds true for extrapulmonary tuberculosis as well. Therefore, this study was undertaken to compare the Auramine-O staining with Ziehl-Neelsen (ZN) staining and Lowenstein Jensen (L-J) media with Mycobacteria Growth Indicator Tube (MGIT) for diagnosis of extrapulmonary tuberculosis. METHODS: A total of 83 extra-pulmonary samples were processed. All the samples were stained by both ZN and Auramine-O method. The samples were inoculated on L-J media and in MGIT after performing the NALC-NaOH (N-Acetyl-L-cysteine NaOH) procedure according to standard protocol. All the isolates obtained were identified biochemically using standard procedures. RESULTS: ZN staining failed to detect acid-fast bacilli in any of the extra-pulmonary samples, while Auramine -O staining detected 5 of the positive cases. Growth on L-J media was obtained in 4 samples while MGIT was positive in 8 samples. INTERPRETATION & CONCLUSIONS: We found out that Auramine-O staining was better than ZN staining and MGIT was better than L-J media for the extra-pulmonary tuberculosis.

To determine the prevalence of syphilis in a tertiary care hospital situated in Hisar, Haryana. The study is a five year study (Jan 2006 to Dec 2010), in which a total of 1550 sera obtained from clinically suspected cases of syphilis and pregnant females were screened for cardiolipin antibodies by the rapid plasma reagin (RPR) test. The total number of males was 650 while the total number of females was 900. The RPR test was positive in 48 patients (3.09%). Out of a total of 850 pregnant females, 10 (1.18%) were tested positive through RPR test. Among the remaining 38 positive patients, males were 35 and females were 3. The most common age group affected was 19–24 years in both the sexes. Our findings showed that there is a substantial benefit of using an economical test like RPR for the diagnosis of syphilis in resource-poor setting. Great importance should be given to the screening of pregnant females for syphilis.

Legionella is an important cause of adult pneumonia and it must be actively considered in both community-acquired and nosocomial pneumonia. The incidence of legionellosis is underestimated for a variety of reasons, which include a lack of clinical awareness, a non-classical presentation, extrapulmonary infections, a delayed seroconversion and a lack of specialized culture facilities or urinary antigen detection tests. More illness is usually found in the summer and in early fall (June to September), but it can occur at any time of the year. It is uncommon in our country, because we are not looking for it hard enough. Unless the doctor looks out and tests for Legionella, these cases are invariably missed. Physicians need to familiarize themselves with the disease, as a prompt recognition and an early treatment can considerably curtail the total outcome in the affected cases and prevent additional cases. Although many aspects about this disease are clear, there are some dark areas regarding the vaccine development, that need to be further explored and understood. The present article details out almost everything which is known about this disease, along with the review of the recent literature.

This study was undertaken to compare sensitivity, time to detection and contamination rates of culture in Mycobacteria Growth Indicator tube (MGIT) and on Lowenstein-Jensen (L-J) media. A total of 300 pulmonary and extra-pulmonary samples were processed. All samples were stained by Ziehl-Neelsen (ZN) and Auramine-O method. The samples were inoculated on L-J media and in MGIT after performing NALCNaOH (N-Acetyl-L-cysteine NaOH) procedure according to standard protocol. All isolates obtained were identified biochemically using standard procedures. Auramine-O staining was more sensitive (64%) compared to ZN staining (48%), while ZN staining had higher specificity (99.64%) than Auramine-O staining (98.20%). The sensitivity of MGIT and L-J media was 95.35% and 58.14% respectively. The mean detection time of LJ medium (32.88 days) was significantly more than MGIT (20.12 days). The contamination rate of MGIT (10%) was higher than L-J medium (7%). (J Infect Dis Antimicrob Agents 2011;29:67-74.) INTRODUCTION Tuberculosis (TB) is the leading cause of death from a curable infectious disease. TB has affected mankind for over 5,000 years, and it still continues to be a leading cause of morbidity and mortality. The bacilli was discovered more than a century back by Sir Robert Koch in 1882 and effective drugs for treatment were available for more than half a century. Globally more than 1.3 million people die of the disease every year. Nearly one third of the world’s population is infected with TB bacilli, approximately 10% of them have a life time risk of developing TB disease.1 The emergence of resistance to drugs used to treat tuberculosis and particularly MDR-TB (MultiDrug Resistant Tuberculosis), has become a 1Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India. 2Dayanand Medical College, Ludhiana, Punjab, India. Reprint request: Dr. Kawal Preet Kaur, MBBS, M.D. (Microbiology), Assistant Professor, Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India. Email: dockawu25@gmail.com

Background & objectives: Tuberculosis is a social disease with medical implications. A presumptive diagnosis of tuberculosis sometimes can be made on basis of patient’s medical history, clinical and radiological findings. It may also include a tuberculin skin test and a serological test. Hence this study was carried out to study the feasibility of various patient characteristics and clinical parameters as a diagnostic aid in tuberculosisMethods: This prospective study was conducted over a period of one year (1August 2009 to 31 July 2010) in the Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana. From 269 suspected cases of tuberculosis admitted in various wards and ICUs, 300 pulmonary and extra-pulmonary samples were received. The patients were diagnosed as suffering from tuberculosis after Auramine staining and culture on Mycobacteria Growth Indicator Tube (MGIT).Results: Majority of the cases were in the age group of 45-64 years. Male: female ratio of 3.33:1. Among the subjects with pulmonary tuberculosis, cough with expectoration (74.19%) was the commonest complaint, whereas among the subjects with extra-pulmonary tuberculosis fever and breathlessness (37.50%) each were common. Among positive cases, consolidation (48.73%) was the most common X-Ray finding followed by pleural effusion (7.69%), whereas in negative cases, consolidation was seen in only 0.43% and pleural effusion in only 0.87% of cases. The mean induration of 16.28 ± 3.95 mm was seen in the positive cases while the mean induration of 6.51 ± 3.96 mm was observed in the negative cases on Mantoux testing. The positive cases had mean ESR (Erythrocyte Sedimentation Rate) of 66.86 ± 20.98 mm/hr while the negative cases had mean ESR value of 16.21 ± 5.48 mm/hr. The mean haemoglobin (Hb), value in the positive cases was 11.74 ± 1.82 g% while the mean haemoglobin value in the negative cases was 11.85 ± 1.70 g%. The positive cases had mean TLC (Total Leucocyte Count) of 7.40 ± 2.62 × 10 /L while the others had mean of 7.35 ± 4.84 × 10 /L. Out of the 269 subjects, 187 were immunized with the BCG vaccine and 82 were nonimmunized.Interpretation & conclusions: Among the various laboratory parameters studied, Mantoux test and ESR values were found to be significantly raised in patients with tuberculosis.

Blood transfusion is an important mode of transmission of infections to recipients. The aim of the study was to assess the prevalence of transfusion-transmissible infections among blood donors. For this, a 3.5-year retrospective study, from October 2002 to April 2006 was conducted at the blood transfusion centre of Maharaja Agrasen Medical College, Agroha (Hisar) Haryana. Donors were screened for seroprevalence of HIV, HBV, HCV and syphilis. A total of 5849 donors were tested, out of which 4010 (68.6%) were replacement donors and 1839 (31.4%) were voluntary donors. The seroprevalence of HIV was 0.3% in the donors. No voluntary donor was found to be positive for HIV. The low sero-positivity among donors is attributed to pre-donation counseling in donor selection. The seroprevalence of HBV, HCV and syphilis was 1.7%, 1.0% and 0.9% respectively in total donors. The seroprevalence of hepatitis and syphilis was more in replacement donors as compared to voluntary donors.