மருத்துவ நுண்ணுயிரியல் & நோய் கண்டறிதல்

Introduction: Typhoid fever is a prolonged illness caused by Salmonella enterica subspecies enterica serotype Typhi, causing an estimated 16.6 million new infections and 600,000 deaths each year. Clinical manifestation of typhoid fever varies from uncomplicated high-grade fever to serious complications involving encephalopathy, peritonitis, perforation and hemorrhage. With development of resistance against commonly used antibiotics, quinolones and third generation cephalosporins are being used against multi drug resistant infections.
Aims and objective: We studied the changing trends of socio-demographic determinants, clinical features and drug resistance pattern among cases of Enteric fever in western Uttar Pradesh in India. so that it may prove helpful to the clinicians for the early diagnosis, management and finally reducing mortality in our region.
Materials and methods: The study was performed on all patients attending Pediatric and Medicine OPD or admitted in wards of Jawaharlal Nehru Medical College and Hospital (J.N.M.C.H), AMU, Aligarh, with clinical presentation suggestive of typhoid fever.
Results: Out of 104 clinically suspected patients 44 (42.30%) belonged to age-group 21-40 years and 55 (52.88%) were males. maximum number of patients belonged to socio-economic class V with 42 (40.38%) patients, majority of the cases were seen during April-June 46 (44.23%), most of the patients were educated up to preschool level consisting of 42 (40.38%). Fever was the most constant symptom in our series representing 104 (100%) patients, Headache was present in 92 (88.46%), abdominal pain in 83 (79.80%) patients, vomiting in 17 (16.34%), coated tongue 24 (23.07%), diarrhoea in 6 (5.77%), and constipation was seen in 8 (7.69%) patients in our study. All the cases 12 (100%) sensitive for the azithromycin, ceftriaxone and Cefoperazone-Salbactum, while 8 (66.67%) cases showed resistance to ampicillin, chloramphenicol, and co-trimoxazole. While cefexime, cefepime and ciprofloxacin were 10 (83.33%), 11 (91.66%), and 10 (83.33%) sensitive. While 2 (16.67%) cases were resistant to nalidixic acid i.e., NARST.
Conclusion: enteric fever is endemic in our country and a significant number of patients are dying each year and frequency of complications is also on rise so knowing the socio-demographic determinants , clinical features and drug resistance pattern among cases may prove useful for the early diagnosis, management and finally reducing mortality.

Introduction: Community associated methicillin resistant Staphylococcus aureus (CA-MRSA) is a growing concern. It causes skin and soft tissue infections (SSTI’s). According to CDC CA-MRSA is currently defined as an infection with MRSA in a person with no prior history of a health care exposure such as hospitalization,surgery ,permanentlv lines or other indwelling devices or hemodialysis. The mec-A gene is responsible for the resistance to methicillin as it alters. Penicillinbinding protein PBP2a to PBP2a’. Panton Valentine Leucocidin toxin infections causes skin and soft tissue infections in CA-MRSA. This toxin carries the gene Luk-PV which is responsible for the pathogenesis of skin lesions. In this study,prevalence of CA-MRSA in the out patient clinics of dermatology, Aligarh is being focused. Aim: To detect the presence of mec A and Luk-PV gene in CA-MRSA. Material and methods: The study was done in patients visiting the out patient department of dermatology with complaints of purulent skin infections. Pus was collected from the lesions after cleaning the surrounding area thoroughly. The sample was immediately transported to the Department of Microbiology for further processing. Out of 250 patients included in the study, 180 samples were positive for Staphylococcus infection. Out of these 180 isolates of Staphylococcus aureus, 80 were methicillin resistant. DNA was extracted from these 80 samples by hotcold method. Multiplex PCR was used to detect both mec A and Luk PV gene , primers used were 310 bp for mec A,433 bp for Luk PV gene. Results: Out of 80 samples, mec A was positive in all 80 samples and Luk PV gene was positive in 46(57.5%) patients and in 34(42.5%) patients Luk-PV was not present. Conclusion: In 30 patients MSSA was isolated which were negative for mec A gene and in 7(23.3%) of these isolates Luk-PV gene was detected. Multiplex PCR assay is simple ,rapid and accurate method and offers the potential for prompt detection of CA-MRSA.

Respiratory and systemic mycoses are globally emerging as problems of increasing importance in infectious diseases. Among the various opportunistic infections, respiratory infections account for up to 70% of AIDS defining illnesses 65 (43.3%) samples were positive for fungal elements on culture. Of 65 isolates, 33 (50.7%) were yeasts and 32 (49.2%) were molds. Amongst the yeast isolates, 21 (63.6%) and 12 (36.3%) were collected from immunocompromised and immunocompetent patients respectively. 14 (42.4%) isolates were of C. albicans; 64.3% from the immunocompromised and 35.7% from the immunocompetent. The remaining 19 (57.5%) isolates of Candida were non albicans candida (NAC). Amongst the 32 (49.2%) mold isolates, 30 (93.7%) were found to be Aspergillus species. A. fumigatus was the most common (53.1%) followed by A. flavus (31.2%) and A. niger (9.3%). Candida isolated from the respiratory secretions does not always indicate invasive candidiasis nor does it indicate the need for antifungal therapy.

Tuberculosis (TB) is one of the most ancient diseases of mankind and has co-evolved with humans for many thousands of years or perhaps for several million years. M. tuberculosis strains that are resistant to the two most potent anti-TB drugs Isoniazid and Rifampicin, are termed as multidrug-resistant TB (MDR-TB) strains. Drug resistance is broadly classified as primary and acquired. Drug resistance in a patient who has never received anti-TB treatment previously or has taken treatment for less than a month is termed as primary resistance. Acquired resistance is the resistance which arises as a result of specific previous treatment. This study was aimed to determine the prevalence of primary MDR-TB in and around Aligarh region by molecular diagnostic method of Line probe assay (LPA). This two year study was carried out in culture and DST Laboratory (RNTCP certified), Department of Microbiology, J.N. Medical College AMU, Aligarh on the sputum samples received of the primary pulmonary tuberculosis suspected patients (according to PMDT guidelines) from the outpatient and inpatient departments of the hospital and from various tuberculosis units in and around Aligarh region from October 2015 to October 2017. Sputum samples were collected from suspected cases of primary pulmonary TB. These samples were subjected to routine microscopy and culture on LJ medium to detect Mycobacterium tuberculosis. Positive cases were subjected to drug sensitivity test by GenoType MTBDRplus Assay. Out of the total 514 samples collected, 265 (51.56%) samples and 326 (63.43%) samples were positive by ZN microscopy and fluorescent microscopy respectively. 312 (60.70%) samples were positive on culture on LJ medium. Total 326 samples which were positive on fluorescent microscopy were subjected to LPA and 47 (9.14%) samples were resistant to both rifampicin and isoniazid, 21 (4.08%) samples were rifampicin mono-resistant and 31 (6.03%) samples were isoniazid mono-resistant.