JEE
VAN
U T
IME
S
Indian Association of Medical Microbiologists– Delhi Chapter www.iammdelhi.com
Editors Poonam Loomba Sonal Saxena Jaswinder Oberoi Renu Gupta Manisha Jain
Volume 2, July 2018
2
Edito ial Tea
D Poo a Sood Loo a
Di e to P ofesso
G B Pa t Hospital Ne Delhi
D So al Sa e a
Di e to P ofesso
Lad Ha di ge Medi al College
Ne Delhi
D Jas i de K O e oi Se io Co sulta t
Si Ga ga Ra Hospital Ne Delhi
D Re u Gupta
Assista t P ofesso
I stitute of Hu a eha iou & Allied S ie es
Delhi
D Ma isha Jai
Assista t P ofesso
VMMC & Safda ja g Hospital Ne Delhi
JEEVANU TIMES
Offi ial pu li atio of I dia Asso iatio of Medi al Mi o iologists-Delhi Chapte
3
JEEVANU TIMES
Offi ial pu li atio of I dia Asso iatio of Medi al Mi o iologists-Delhi Chapte
Ta le of o te ts
Re ie a ti le
Clostridiu diffi ile i fe tio : a e ie of lite atu e
Bha a Sha a
VMMC & Safda ju g Hospital, Ne Delhi.
Pg -
Cli i al Case Repo t
Se e e hae o hagi p eu o o al p eu o ia i a hild: A a e o pli a-tio
Pooja Sha a, Shali i De a Duggal, Re u Gu , Stuti Kaushik, Ta isha Bha a a, Ma oj Ga g, Deepti Jai
D . BSA Hospital, Delhi
Pg -
Aspe gillosis i a patie t o e t a o po eal e a e o ge atio suppo t
Poo i a Se , Ba sidha Ta ai, P ag a P Je a
Ma Supe spe ialit Hospital, Ne Delhi
Pg -
A ase epo t of isdiag osed east a s ess
Pu a i Ba a , Ta u Thuk al, Shi pi Chop a, Sa deep Na a
BLK Supe Spe ialit Hospital, Ne Delhi
Pg -
Mi o iolog updates f o a ou d the o ld
Pg -
Mi o iolog uiz
Pg
4
F o the edito ’s desk
G eeti g a d el o e to the e t editio of Jee a u Ti es. The o je ti e of Jee a u
Ti es is to pu lish up-to-date, high- ualit a d o igi al esea h pape s alo gside ele-
a t a d i sightful e ie s a d to e ou age the ou g i o iologists to pu lish thei
a ti les. As su h, the e slette aspi es to e i a t, e gagi g a d a essi le, a d at
the sa e ti e i fo ati e a d useful. This issue o tai s a e ie a ti le o Clost idi-
u diffi ile i fe tio : a i fe tio hi h is e o i g i easi gl p e ale t ith the is-
use of a ti i o ials. We also ha e a se ies of ase epo ts o a e a u usual p ese ta-
tio s of Aspe gillosis, se e e p eu o o al hae o hagi p eu o ia a d isdiag o-
sis.
A pape s that ou ish to su it, a e u h app e iated a d ill ake a su sta tial
o t i utio to the su ess of this e slette . Best ishes a d tha k ou i ad a e fo
ou o t i utio to the Jee a u Ti es
With est ishes
D Poo a Sood Loo a
Edito
Jee a u ti es
5
Clostridiu diffi ile i fe tio : a e ie of lite atu e
Autho : D . Bha a Sha a
Depa t e t: Depa t e t of Mi o iolog
I stitute: VMMC & Safda ju g Hospital, Ne Delhi.
Co espo di g autho : ha a @g ail. o
Re ie arti le
I trodu tio
Clostridiu diffi ile C. diffi ile is o idel
e og ized as the leadi g ause of oso o ial
dia hea o ld ide ith asso iated su sta tial
o idit a d o talit [ , ]. Re e t data sug-
gest a i ease i oth the i ide e a d se-
e it of C. diffi ile i fe tio CDI [ ]. O e
, , people eed hospital a e a d at least
, people die f o CDI i the U ited States
ea h ea ased o statisti s f o the Ce te s
of Disease Co t ol a d P e e tio [ ]. Clost idi-
u diffi ile C. diffi ile is a G a -positi e,
st i tl a ae o i , spo e-fo i g a te iu that
auses a spe t u of p ese tatio a gi g f o
ild, self-li iti g dia hea, to se ious dia hea,
pseudo e a ous olitis a d life-th eate i g
ful i a t olitis, hi h a esult i death [ ].
It as fi st isolated i f o fe es a d e-
o iu of as pto ati e o i fa ts, a d
as o igi all a ed Ba illus diffi ilis e ause
of its o pholog , a d e ou te ed the diffi ul-
ties i ulti ati g it [ ]. Si e the , it as e-
lie ed to e a o e sal o ga is u til the
late s, he it as e og ized as the etio-
logi age t of pseudo e a ous olitis [ ].
Pathoge esis
I o de fo C. diffi ile to ause disease, se e al
i po ta t o -ditio s ust e et. A pe so
ust ha e o ta t ith the spo es of a to i -
p odu i g st ai of C. diffi ile i o i atio
ith alte atio of the o al olo i i o io-
ta, pe itti g olo iza-tio of the o ga is .
CDI de elops he a patie t i gests the spo es
of a to ige i st ai of C. diffi ile ia pe so al
o ta t o e i o e t. A o g health peo-
ple, C. diffi ile does ot ause p o le s due to
i pa t o e sal o el flo a a d a ti od -
ediated i u it ; ho e e , i the setti g of
a a o al o dis upted olo i u osa,
these spo es olo ize the o el a d su se-
ue tl ge i ate, a d egetati e a te ia
sta t p odu i g t o la ge to i s, a e te oto -
i , T dA, a d a toto i , T dB, hi h a e e -
oded t dA a d t dB, espe ti el [ ]. To i
A, auses i eased i testi al pe ea ilit a d
fluid se etio . To i B, leads to i te se olo i
i fla atio . To i s ou d to e epto s gai
i t a ellula e t odifi atio of Rho p o-
tei s-s all gluta l t a speptidase- i di g
p otei s. These p otei s a e i ol ed i
6
a ti pol e izatio , toskeletal a hite -
tu e, a d ell o e e t. The esulta t effe t
is the loss of i te ellula tight ju tio s lead-
i g to se eta dia hea, a d a i fla ato-
espo se ith e e tual ell death [ ]. The
fa t that a ti ioti s alte the gut i o iota
has ee esta lished si e the s, sho tl
afte st epto i e a e a aila le a d i -
estigato s oted the i pa t of o al ad i -
ist atio of this age t o the a te ia p ese t
i the fe es of i e[ ]. A ti ioti s a e the
ajo isk fa to fo the de elop e t of C.
diffi ile disease e ause of the loss of e dog-
e ous i o iota that allo s C. diffi ile,
he p ese t, to p olife ate a d i ade. Se -
e al i te esti g studies of the gut i o i-
o e usi g ultu e-i depe de t ethods
ha e elu idated the sig ifi a t alte atio s
that fol-lo a ti ioti ad i ist atio [ , ].
Othe i po ta t i ule e fa to s that o -
t i ute to the pathoge esis of C. diffi ile i -
lude adhesi s, fi iae, flagella, a apsule,
a d a pa a stalli e S-la e p otei
i po ta t i ellula adhesio [ - ].
Risk fa tors
The hief isk fa to fo the disease is p io to
e pose a ti i o ials. I the hospital setti g,
the ajo it of CDI ases is asso iated ith
the use of a ti ioti s. Ho e e , up to / of
ases of o u it -a ui ed CDI i a e e t
stud did ot ha e a ti ioti s i the da
p io to the de elop e t of s pto s sug-
gesti g a diffe e t patte of disease et ee
o u it -a ui ed a d oso o ial ases [ ].
The isk of de elopi g disease afte e posu e to
a ti i o ials is highl a ia le a d depe ds o
host fa to s age, diet, i u e s ste fu tio ,
et . , the t pe a d dose of a ti ioti , a d the du-
atio of t eat e t. Although li da i usage
as losel li ked ith the disease histo i all
a d still o stitutes to e a ajo isk fa to ,
o e ases at the p ese t a e att i uted to the -
ap ith β-la ta age ts e ause of thei o -
o use [ ]. Othe isk fa to s i lude ad-
a ed age > ea s , e e t su ge
t a spla t, gast oi testi al p o edu es , p oto
pu p i hi ito s, i u osupp essa t, u de l i g
de ilitati g o ditio s, i fla ato o el dis-
ease, p olo ged hospitalisatio > d , a d a-
sogast i tu e feedi g [ , ].
Cli i al features
The i u atio pe iod et ee spo e i gestio
a d the o set of the disease has ot ee dete -
i ed. Ho e e , ost patie ts de elop dia hea
du i g o sho tl afte taki g a ti ioti s, o up to
- eeks afte its dis o ti uatio [ , ]. CDI
has a ide spe t u a ge of li i al p ese ta-
tio s f o ild, self-li iti g dia hea, to se ious
dia hea, pseudo e a ous olitis a d life-
th eate i g ful i a t olitis, hi h a esult i
death. Wate dia hea is the a di al s pto
of CDI[ ]; it a ies f o ild, ode ate to se-
e e. Patie ts ith olitis ith o ithout pseu-
do e a ous olitis usuall p ese t ith ate-
7
dia hea up to - ti es dail , a -
do i al a pi g a d pai , fe e , a o e ia
a d ausea [ ]. The li i al p ese tatio of
CDI a ges f o as pto ati a iage, to
ild o ode ate dia hea, to ful i a t oli-
tis [ , ]. Th ee o o e ate , o lood
stools pe -h pe iod is the hall a k of
s pto ati ill ess [ ]. Mild disease is
ha a te ized dia hea i the a se e of
sig s a d s pto s of olitis he eas od-
e ate disease is ha a te ized ode ate
dia hea ith olitis a ifested fe e , a -
do i al a ps a d dis o fo t, usuall i
the lo e uad a ts [ ]. Se e e disease is
ha a te ized hite lood ell ou t of
> , ells/μL, se u al u i < g/dL,
a d/o a se u eati i e le el ≥ . ti es
the p e o id le el [ ].
The li i al featu es of CDI/ful i a t olitis
i lude fe e , dia hea leadi g to h po ole-
ia, se e e lo e uad a t o diffuse a -
do i al pai , a do i al diste tio , se e e
la ti a idosis, h poal u i e ia, a d sig ifi-
a t leuko tosis , hite lood ells/
μL o highe [ ]. Ful i a t olitis a lead
to o el pe fo atio a d to i ega olo .
Othe o pli atio s of C. diffi ile i lude
ele t ol te i ala e, e al failu e f o se-
e e deh d atio , s ste i i fla ato e-
spo se s d o es a d sepsis [ ].
La orator ethods for Clostridiu
diffi ile dete tio :
The diag osis of CDI is ased o the li i al fea-
tu es, o fi atio of the p ese e of eithe to -
i A alo e o to i s A a d B togethe i the stool,
a d so eti es e dos op to e if pseudo e -
a ous olitis. CDI should e suspe ted i a
hospitalized patie t ho de elops dia hea o
a pe so i the o u it ho de elops dia -
hea afte a ou se of a ti ioti s o i asso iatio
ith i u osupp essi e the ap . CDI should o -
l e i estigated i patie ts ith dia hea. Diag-
osti tests a aila le i lude e z e i u oas-
sa s EIA fo to i s, EIA fo C. diffi ile gluta ate
deh d oge ase GDH a d u lei a id a plifi a-
tio tests NAATs, o Pol e ase hai ea tio
PCR fo C. diffi ile to i ge es. Othe diag osti
tests i lude to ige i ultu es, o ell ultu e
eut alizatio assa s CCNA [ ]. O e st ateg
to i p o e se siti it is th ough a t o-step
ethod that uses EIA dete tio of GDH as a i i-
tial s ee . A tige -positi e spe i e s fo GDH
a d egati e fo to i s if tested a e fu the
assessed usi g a NAAT o CCNA. To ige i ul-
tu e is o side ed the gold sta da d; ho e e its
use li ited i the li i al setti g gi e the du a-
tio of ti e fo ultu e esults to e o e a aila-
le. NAATs e.g. PCR a e highl spe ifi > % ,
a d highl se siti it apid tests fo C. diffi ile
dete tio . This diag osti test affo ds a ui k a d
effi ie t a of dete ti g CDI [ ]
8
Ma age e t of CDI
T eat e t of C. diffi ile i fe tio i ol es
stoppi g s ste i a ti ioti s if possi le p o-
ide app op iate suppo ti e a e ith h d a-
tio a d ele t ol te epla e e t as eeded.
Studies ha e i di ated highe u e ates a d
de eased elapse i patie ts i ho a ti i-
oti s e e dis o ti ued [ , ]. Met o ida-
zole a d a o i a e the p i ipal d ugs
used to t eat C. diffi ile i fe tio . Patie ts
ith ild o ode ate dia hea a e ge e all
t eated ith et o idazole g TID fo
to da s, as studies ha e i di ated si i-
la u e ates ith eithe et o idazole o
a o i . Patie ts ith se e e dia hea
a e t eated ith a o i to g
QID fo - da s, as patie ts ith o pli-
ated C. diffi ile had a u e ate of % ith
et o idazole o pa ed to % ith a o-
i . Re u e e ates e e also highe
ith et o idazole. Adju t the ap is ith
a o i e e a g i l sali e
a d /o i t a e ous et o idazole. Su ge
ith total ole to is i di ated i se e e
olitis ith sig ifi a t to e i s pto s[ ].
Othe a ti ioti s that a e o side ed as
alte ati e the ap fo CDI i the u usual
e e ts e.g. alle g o i tole a e to oth
fi st- li e age ts i lude fida o i i , a it a-
i , tei opla i , fusidi a id a d itazo a-
ide, ifa i i a d ifa pi . Most of the a -
ti e o pa ato studies fou d o statisti all
sig ifi a t diffe e e i effi a et ee a o-
i a d these age ts fo i itial the ap of CDI
e ept tei opla i a d fida o i i . The e o -
e ded dose is g e e hou s fo
da s. Tei opla i appea s to e ette tha a -
o i fo a te iologi u e a d has o de li e
supe io effe ti e ess i te s of s pto ati
u e, hile fida o i i appea s supe io to a -
o i i te s of lo e e u e e ates a d
glo al li i al u e ates i.e., li i al u e ates
o i ed ith e u e e ates . No e a ti i-
o ial the apies su h as i t a e ous i u o-
glo uli , spe ifi o o lo al a ti odies the ap ,
to i - i di g age ts e.g., holest a i e,
tole a e , p o ioti s [e.g., Sa ha o es ou-
la dii S. oula dii ] a d fae al the ap ha e ee
studied fo use as sta d-alo e t eat e ts o i
o i atio ith sta da d the ap fo CDI. Su -
gi al i te e tio ole to is i di ated i pa-
tie ts ith to i ega olo ho a e ot e-
spo di g to edi al t eat e t, i patie ts ith
o goi g se e e sepsis despite a ti ioti t eat-
e t, a d/o he olo i pe fo atio is li i al-
l suspe ted [ , ].
Recurrent CDI
Between 20% and 35% of patients with CDI will fail initial antibiotic treatment and, of these, 40–60% will have a second recurrence. The majority of recurrences are due to relapses of CDI with the original strain rather than re-infection with a dif-ferent strain . Resistance to vancomycin or metro-nidazole is not considered a factor in recurrent CDI, but such antibiotics may contribute to con-tinued intestinal dysbiota. Recurrent infection is
9
o ti ued i testi al d s iota. Re u e t i -
fe tio is o e o o i olde patie ts
> ea s , fe ales, Cau asia patie ts,
those ith u e t a ti ioti use, o o i-
ta t use of p oto pu p i hi ito s a d o e
se e e i itial disease. The p ese e of o o -
idities, a ti- eoplasti he othe ap , i ad-
e uate IgG a ti od espo se to To i A
afte i itial episode, i fla ato o el dis-
ease, o ga t a spla tatio , h o i kid e
disease, h poga aglo uli ae ia, i u o-
defi ie a d e posu e to a i fa t a ie
o i fe ted adult ha e also ee e og ized
as isk fa to s . The o t i utio of p oto
pu p i hi ito s PPIs to CDI e ai s u -
lea . C. diffi ile spo es a e esista t to gas-
t i a id, ut egetati e fo s a e sus epti-
le. I o u it -a ui ed CDI patie ts, PPI
e posu e as o se ed i % of patie ts
ith CDI, ith o e posu e to a ti ioti s .
The e ha e ee epo ts of i eased CDI isk
ith PPIs; ho e e , othe studies ha e e-
po ted o i ease i isk follo i g adjust-
e t fo o-e iste t o ditio s [ – ]. P o-
ioti s a a t th ough a u e of e ha-
is s. These i lude te po a olo izatio ,
p odu tio of a te i idal a ids a d peptides,
a d o petitio ith C. diffi ile fo ut ie ts
a d epithelial adhesio . La to a illi ha e
ee sho to supp ess g o th of C. diffi ile
i ha ste s [ ].
Pre e tio
P e e tio of CDI is halle gi g health au-
tho ities. Ho e e , p e e ti e easu es a e tak-
e su h as i ple e tatio of i fe tio - o t ol
easu es o ta t isolatio a d follo i g good
ha d - ashi g e e o e . I additio , the
o e sto e to o t olli g this i fe tio is the
o t ol of a ti i o ial p es i i g. A ultidis i-
pli a a ti ioti a age e t p og a to e-
st i t the i app op iate use of a ti ioti s a
lead to a sig ifi a t de ease i oso o ial i fe -
tio s aused C. diffi ile[ ]
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- .
. Ba tlett JG. Cli i al p a ti e. A ti ioti -
asso iated dia hea. N E gl J Med
; : - .
. Kell CP, LaMo t JT. Clostridiu diffi ile-
o e diffi ult tha e e . N E gl J Med
; : - .
. Bu ha C-AD, Ca oll KC. Diag osis of Clos-
tridiu diffi ile i fe tio : a o goi g o u -
d u fo li i ia s a d fo li i al la o ato-
ies. Cli Mi ro iol Rev ; : - .
. Ko a TM. Diag osis a d a age e t of
Clostridiu diffi ile i fe tio . Se i Respir
Crit Care Med ; : - .
. Su a i z CM, B a dt LJ, Bi io DG, et al.
Guideli es fo diag osis, t eat e t, a d p e-
e tio of Clostridiu diffi ile i fe tio s. A
J Gastroe terol ; : - .
. Bulusu M, Na a a S, Shetle K, T iada-
filopoulos G. Leuko tosis as a ha i ge a d
su ogate a ke of Clostridiu diffi ile i fe -
tio i hospitalized patie ts ith dia hea.
A J Gastroe terol ; : - .
. Kufel i ka AM, Ki TJ. Effe ti e utilizatio of
e ol i g ethods fo the la o ato diag osis
of Clostridiu diffi ile i fe tio . Cli I fe t Dis
; : - .
. Mu ad YM, Pe ez J, Nokh eh R, et al. I pa t
of pol e ase hai ea tio testi g o Clos-
tridiu diffi ile i fe tio ates i a a ute
health a e fa ilit . A J I fe t Co trol
; : -
. Gould CV, M Do ald LC Be h-to-
edside e ie : Clost idiu diffi ile olitis.
C it Ca e : .
33. Mulla e KM, Mille MA, Weiss K, Le t ek A,
Gola Y, et al. Effi a of fida o i i
e sus a o i as the ap fo Clost idiu
12
diffi ile i fe tio i i di iduals taki g o -
o ita t a ti ioti s fo othe o u e t
i fe tio s. Cli I fe t Dis : - .
. Za FA, Bakka aga i SR, Moo thi KM, Da-
is MB A o pa iso of a o -
i a d et o idazole fo the t eat e t
of Clost idiu diffi ile asso iated dia -
hea, st atified disease se e it . Cli
I fe t Dis : - .
. Nelso RL, Kelse P, Lee a H, Mea do
N, Patel H, Paul K, et al. A ti ioti t eat-
e t fo Clost idiu diffi ile-asso iated
dia hea i adults. Co h a e Data ase
S st Re ; doi: . / .
CD .pu .
. Che g AC , F e guso JK, Ri ha ds MJ,
Ro so JM, Gil e t GL, M G ego A, et al.
Aust alasia so iet fo i fe tious diseas-
es guideli es fo the diag osis a d t eat-
e t of Clost idiu diffi ile i fe tio .
Med J Aust ; : -
. Asla S, Ha ill RJ, Mushe DM. T eat-
e t of Clost idiu diffi ile- asso iated
disease: old the apies a d e st ategies.
La et I fe t Dis ; : – .
. Co el OA, Mille MA, Louie TJ et al. T eat-
e t of fi st e u e e of Clost idiu
diffi ile i fe tio : fida o i i e sus a o-
i . Cli I fe t Dis ; Suppl :S –
.
. Kell CP, LaMo t JT. Clost idiu diffi ile—
o e diffi ult tha e e . N E gl J Med
; : – . Lo I, Mol i e DC, Lea
BA et al. T eat e t ith o o lo al a ti od-
ies agai st Clost idiu diffi ile to i s. N E gl J
Med ; : –
. M Fa la d LV, El e GW, Su a i z CM.
B eaki g the le: t eat e t st ategies fo
ases of e u e t Clost idiu diffi ile
disease. A J Gast oe te ol ; : –
.
. M Fa la d LV, Su a i z CM, G ee e g RN et
al. A a do ized pla e o- o t olled t ial of
Sa ha o es oula dii i o i atio ith
sta da d a ti ioti s fo Clost idiu diffi ile
disease. JAMA ; : – .
. Naa e P, Mikelsaa M. I te a tio s et ee
La to a illi a d a ti ioti -asso iated dia -
hea. Ad Appl Mi o iol ; : – .
. S h oede MS. Clost idiu diffi ile-asso iated
dia hea. A Fa Ph si ia ; : -
Ou fa ou ite u pe sti ke :
"Suppo t a te ia; it is the o l ultu e e ha e left."
Did ou hea a out the fa ous i o iologist ho isited diffe e t ou t ies a d spoke la guages?
He as a a of a ultu es
13
I trodu tio
Co u it a ui ed p eu o ia CAP i i-
de e is illio ases pe ea of hi h
% ases e ui e hospitalizatio . Mo talit
ate is et ee - %, hi h a ise upto
% i i te si e a e u it ICU .[ ] Hae o -
hagi p eu o ia HP is defi ed as p eu o-
ia o pli ated pul o a hae o hage
hi h a fu the lead to hae o hagi
pleu al effusio . Most o o i fe tious
auses of HP i lude Pa to -Vale ti e Leu-
ko idi p odu i g Staph lo o us aureus,
Strepto o us p oge es, Ste otropho o as
altophilia, Chala dia p eu o iae, i flu-
e za i uses et . Ra e auses i lude pul o-
a a th a , p eu o i plague, alle gi
o ho-pul o a aspe gillosis ABPA ,
P eu o stis jirove ii p eu o ia, leptospi-
osis, u ellosis, Va i ella Zoste , a d Pa ai -
flue za i uses, et .[ ] No -i fe tious auses
i ludet au a, hae o hagi diathesis, pul-
o a th o oe oli diseases, pleu o-
pul o a alig a , sple i i ju , et .[ ]
Strepto o us p eu o iae is a leadi g ause of
CAP ith asso iated pa ap eu o i effusio s i
o e tha % of ases. [ ] Se e it depe ds up-
o age, asso iated o- o idities, i u e status
et . He e e dis uss a a e ase of hae o hagi
p eu o o al p eu o ia ith effusio i a -
ea -old hild. O lite atu e sea h th ough i te -
et, e did ot fi d a si gle ase of hae o hag-
i pleu al effusio due to p eu o o us.
Case Report
A - ea -old ale hild as ad itted to paediat-
i e e ge depa t e t ith histo of ough
a d fe e fo da s, fast eathi g a d de-
eased o al a epta e fo da s. The e as o
histo of p e ious hospitalizatio o i u iza-
tio ith p eu o o al a i e. The e as o
othe sig ifi a t past histo .
O ge e al ph si al e a i atio , patie t
as si k, asal fla i g as p ese t, lood p es-
su e / Hg, hea t ate eats/ i ,
te pe atu e °F, espi ato ate RR / i ,
o ge satu atio %. O hest e a i atio ,
Se e e hae o hagi p eu o o al p eu o ia i a hild: A a e o pli atio
Autho s: Pooja Sha a , Shali i De a Duggal , Re u Gu , Stuti Kaushik , Ta isha Bha a a ,
Ma oj Ga g , Deepti Jai ;
Depa t e t: Depa t e t of Mi o iolog Depa t e t of Paediat i s
I stitute: D . BSA Hospital, Se to , Rohi i, Delhi-
Co espo di g autho : shali iduggal @ ediff ail. o
Case report
14
the e e e de eased hest o e e ts ith
sto dull ote o pe ussio a d a se t
eath sou ds i ight lu g o aus ultatio .
Rest of the s ste i e a i atio as o -
al. Total leu o te ou t TLC as /µl,
platelet ou t /µl, hae oglo i . g/
dL. I itial ed side hest X- a sho ed ight
sided pleu al effusio . Pleu al tap as do e
o sa e da of ad issio , hi h tu ed out
to e hae o hagi . I te oastal hest tu e
ICD as i se ted. As pe the A e i a tho-
a i so iet guideli es, si e the patie t
sho ed th ee i o ite ia fo se e e CAP
i eased RR, th o o tope ia, ulti lo a
i filt ates patie t as kept u de i te si e
a dio espi ato o ito i g.[ ]
Patie t as i ediatel t eated e -
pi i all ith i t a e ous eft ia o e g,
hou l a d a o i g, hou l .
Pleu al fluid as se t fo g a stai a d ul-
tu e. A possi ilit of de gue hae o hagi
fe e DHF as also o side ed a d o e u it of
f esh f oze plas a as t a sfused. Ult aso og-
aph of hest o da of hospital sta sho ed
ight sided septal olle tio i lu g a d ultiple
ai fo i ith asal o solidatio . High esolutio
o puted to og aph featu es e e o siste t
ith ult aso og aph suggesti e of hae otho-
a . Pat h a eas of o solidatio e e also see
i left uppe a d lo e lo e, though left osto-
ph e i a gle as lea . Multiple e la ged
p e as ula g oup of l ph odes e e also
see .
G a stai of pleu al aspi ate e ealed
a pus ells a d g a positi e diplo o i, sug-
gesti e of p eu o o al i fe tio . Ziehl Neelse
stai fo a id fast a illi as egati e. Cultu e
g e S. p eu o iae. A ti ioti sus epti ilit
testi g AST Ki Baue ethod sho ed se -
siti it to pe i illi o a illi , a o illi -
la ula i a id, hlo a phe i ol, ip oflo a i ,
eft ia o e, le oflo a i , li ezolid a d pipe a il-
15
Isolate as esista t to li da i , o-
t i o azole a d e th o i . Follo i g the
AST epo t, le oflo a i g/kg/da as
added to the i itial egi e o da th ee.
De gue se olog , lood ultu e e e ega-
ti e, & sputu ultu e as u e a ka le.
Cli i al ourse duri g hospital sta
Du i g fi st si da s of sta , TLC a d te pe a-
tu e i eased to /µL a d °F e-
spe ti el , etu i g to o al da eight.
Platelet ou t a d RR e a e o al the
si th da . Hae o hagi fluid kept o de-
easi g o e da s a d ICD as e o ed o
da of ad issio . Patie t’s dist ess also
kept o de easi g o e ti e, ith O satu a-
tio ai tai ed at - %. He sta ted a -
epti g o al feeds, as dis ha ged o da
afte gi i g fi st dose of p eu o o al a -
i e a d as ad ised to follo up. Follo up
isit at o e o th sho ed esolutio ith
o plete e o e .
Dis ussio
This ase highlights the a e p ese tatio of
ost o o a te ia asso iated ith CAP.
The p ese tatio as o siste t ith se e e
p eu o ia ut hae o hagi tap poi ted
to a ds diffe e tial diag osis of DHF i ie
of u e t de gue out eak, hae o hagi
pleu al effusio , fe e a d th o o tope-
ia. O e g a positi e diplo o i e e see
o g a stai a d fu the S. p eu o iae
g e o pleu al fluid ultu e, a ti ioti s e e
fu the atio alized. This isolate sho ed e-
sista e to a olides a d li osa ides ut sus-
epti ilit to β la ta s a d flu o uoi oles FQ .
He e a o i atio of a β la ta a d FQ as
gi e as pe ATS guideli es fo i patie t, ICU
t eat e t. [ ]
I asi e p eu o o al disease is defi ed
as a i fe tio o fi ed S. p eu o iae iso-
latio f o ste ile sites e.g. e e ospi al fluid,
pleu al fluid a d lood.[ ] Mo talit ate a ies
f o - % i i asi e disease ut a go upto
% i se e e ases.[ ] I i asi e disease, se -
o da o pli atio s su h as a th itis, e i gi-
tis, e do a ditis a d o a ditis a o u .
T eati g ph si ia should ha e high diag osti
suspi io of the . [ , ] Ou patie t as ought i
a e si k o ditio ith hae o hagi p eu o-
o al p eu o ia a d had asso iated a poo
p og osti fa to s like ou g age, ICU ad issio
a d high RR. Ti el edi al a d su gi al i te -
e tio s i the paediat i e e ge depa t e t
itself follo ed defi ite i o iologi al diag o-
sis helped the patie t su i e.
Refere es
. P asad P a d Bhat S. Cli i o i o iologi al
stud of o u it -a ui ed p eu o ia.
Lu g I dia. ; : – .
. A aila le f o : https:// adiopaedia.o g/
a ti les/hae o hagi -p eu o ia. [Last a -
essed o Ju e ].
. Ma ko iak PA, Sellie P , Mo suez JJ, Fadel E,
16
E a s J,Vitte o D. A U usual Cause of
He o hagi Left Pleu al Effusio . Cli i al
I fe tious Diseases. 2006; : – .
https://doi.o g/ . / . A ail
a le f o : https: e edi
i e. eds ape. o /a ti le/ -
o e ie .
. I fe tious Diseases So iet of A e i a/
A e i a Tho a i So iet Co se sus
Guideli es o the
. Ma age e t of Co u it -A ui ed
P eu o ia i Adults Cli i al I fe tious
Diseases ; :S – .
. Ce te s fo Disease Co t ol a d P e e -
tio , I asi e p eu o o al disease
IPD Strepto o us p eu o iae
ase defi itio , . A aila le f o :
https:// . d .go / dss/ o ditio s/
i asi e-p eu o o al-disease/ ase-
defi itio / /.[Last a essed o Ju e
].
. Li WS, Baudoui SV, Geo ge RC et al. B itish
Tho a i So iet guideli es fo the a age-
e t of o u it a ui ed p eu o ia i
adults: update . Tho a . ; ,iii –
iii .
. Rou A, Ca al a tiM, Ma os M et al. I pa t
of al ohol a use i the etiolog a d se e it
of o u it -a ui ed p eu o ia, Chest.
; : – .
. B o AO, Ma B, Gao G et al. St epto o -
us p eu o iae t a slo ates i to the o-
a diu a d fo s u i ue i olesio s that
dis upt a dia fu tio . PLoS Pathoge s.
: :e .
A oss
. I e to of Hot ai o e : Ko h
. JC Pol o a i us auses: PML
. Rapid ethod fo TB diag osis: CBNAAT
. Cell all defi ie t fo : P otoplast
. Ce i al a e ell li e: HeLa
. Spo e stai i g ethod: Fulto
. Disease aused U eaplas a: NGU
. Mediu fo Ca p lo a te : Ski o
. Zoo oti disease ith hepato e al i -ol e e t: Weil
. Cells see i agi osis: Clue
. West Af i a he o hagi fe e : lassa
Do
. Ve to o e age t asso iated ith Mi-o ephal : Zika
. Pig e t see i P e otella: he i
. Beta La ta a ti e agai st MRSA: eft-ip ole
. Test fo p eu o o us: Opto hi
. Rea tio o stai i g A th a a illi f o lood fil s:M Fa dea
. Adoles e t a i atio i di ated fo : HPV
. Risus Sa do i us is see i : Teta us
. L ti a ea o a te ial ultu e phage:Pla ue
. T epo e a a ateu is etiologi al
Answers to Microbiology quiz published in Jeevanu Times January
17
Case report
Aspergillosis i a patie t o e tra orporeal e ra e o ge atio support
Autho s: D Poo i a Se , D Ba sidha Ta ai, D , P ag a P Je a
Depa t e t: Depa t e t of Mi o iolog
I stitute: Ma Supe spe ialit Hospital, Saket, Ne Delhi
Co espo di g autho : Ba sidha .Ta ai@ a health a e. o
I trodu tio
E t a o po eal e a e o ge atio
ECMO fo i te si e a e patie ts ith se-
e e a dia o e e si le pul o a failu e
has e o e o e o o o e the last fe
ea s[ ].Co pli atio s esulti g f o ECMO
fu the i ease the o talit i this g oup of
patie ts, hi h is al ead high due to se e it
of u de l i g ill ess [ ]. Patie ts o ECMO
a e ofte e ei i g oad-spe t u a ti i-
oti s; the ha e ultiple e t poi ts fo
pathoge s a d thei i u e s ste is i -
pai ed lood i uit i te a tio . These fa -
to s a e thought to p edispose the to fu -
gal i fe tio s spe iall Ca dida spp. a d As-
pergillus spp [ ]. We he e des i e a ase
he e ECMO as used as a pa t of the a -
age e t of a patie t of ILD ith ARDS A ute
espi ato dist ess s d o e a d the pa-
tie t de eloped i asi e pul o a aspe gil-
losis.
Case: A ea old ale k o ase of h pe -
te sio , Dia etes ellitus t pe II, h poth oidis
a d i te stitial lu g disease as ad itted i
so e othe hospital o / / ith o -
plai ts of fe e a d eathless ess. Fu the i -
estigatio o fi ed ILD ith supe added es-
pi ato i fe tio . Patie t as ot o a t eat-
e t fo ILD i spite of ei g; it as diag osed i
Jul . He as gi e a ti ioti s, ste oids a d
othe suppo ti e a age e t. I et ee pa-
tie t as little i p o ed ho e e agai de el-
oped eathless ess, shifted to ICU, put o BIPAP
suppo t a d IV a ti ioti s. I spite of all the
effo ts the eathless ess as pe siste t a d pa-
tie t as shifted to ou hospital o / / .
Afte ad issio to ou hospital the la pa a e-
te s e e as follo s He oglo i - . g ./dl,
Platelet ou t as . lakhs/ µl, total leu o te
ou t as , /µl , se u C eati i e . g/
dl , INR . . Se u C eati i e as i easi g
a d u i e output as de easi g g aduall , Pa-
tient was in persistent hypoxia even on 100% FiO2 and was going into metabolic and respirato-
18
-to a idosis so he as put o ECMO sup-
po t. Be ause of poo li i al p og essio a d
pe siste t espi ato i suffi ie BAL sa -
ples e e se t fo i o iologi al i estiga-
tio s. Both BAL a d se u sa ple e e se t
fo gala to a a GM assa . I fu gal i-
os op KOH ou t septate fu gal h phae
ith a ute a gle a hi g e e see . Asper-
gillus flavus as also isolated f o BAL ul-
tu e late o .
Chest X a sho ed ilate al opa ities ,
oth se u a d BAL gala to a a as pos-
iti e so o i o azole g BD IV a d Cas-
pofu gi g IV as sta ted alo g ith
othe suppo ti e a age e t. F o th da
of ad issio ili u i sta ted to ise apid-
l .Ult asou d i agi g of uppe a do e
e ealed ild to ode ate as ites a d i t a-
hepati holestasis se o da to s ste i
ill ess. The e as pe siste t ise of ili u i
so o i o azole as stopped a d liposo al
a phote i i B g/kg alo g ith a idula-
fu gi g IV e e sta ted. I spite of that
ge e al o ditio of patie t e ai ed iti-
al, he as i espi ato failu e, dist i uti e
sho k ith h pe ili u i e ia.
Total se u ili u i as still . g/dl
o th da of ad issio othe pa a ete s
e e also o ti ui g to e de a ged a d
o se ed fu the . Blood ultu e as fou d
to e positi e fo E tero a ter loa ae , a ti-
ioti olisti MU IV as added to t eat-
e t. No the patie t as a ase of I asi e
Aspe gillosis, E tero a ter lood st ea i fe -
tio , espi ato failu e o ECMO, dist i uti e
sho k, eta oli a idosis, a do i al diste sio ,
h pe ili u i e ia. Patie t ulti atel su -
u ed to death o th da of ad issio .
Dis ussio :
Aspe gillus is a u i uitous e i o e tal h ali e
ould. T pi all , i asi e aspe gillosis IA affe ts
patie ts ith i he ited i u e defi ie ies, ad-
a ed HIV i fe tio , p olo ged eut ope ia a d
alloge ei he atopoieti ste ell t a spla ta-
tio HSCT [ ]. Aspe gillosis is also a e e gi g
oppo tu isti i fe tio i iti all ill patie ts i
the ICU, pa ti ula l i patie ts ith COPD o se-
e e li e disease [ ]. F o the last fe de ades
the use of ECMO fo the a age e t of life
th eate i g pul o a o a dia failu e has i -
eased. P olo ged ECMO use has ee ide ti-
fied as a isk fa to fo ECMO- elated oso o ial
i fe tio [ , ]. Patie ts a e at isk of oso o ial
i fe tio hilst o ECMO as the ha e ultiple
po tals of e t [ , ].
We he e epo ted a ase of i asi e aspe gil-
losis i a patie t follo i g ECMO t eat e t.
The e a e th ee ajo t pes of o hopul o-
a Aspe gillus i fe tio s: i asi e aspe gillosis,
h o i aspe gillosis, a d alle gi aspe gillosis.
Aspe gillosis i fe tio a also a ifest as si us
disease i i u o o p o ised hosts. If left u -
t eated, i asi e aspe gillosis a ha e o talit
app oa hi g %. I ases of suspe ted i asi e
aspe gillosis, a e te si e diag osti o kup is
19
is e essa , ut t eat e t should e i itiat-
ed as ea l as possi le to edu e o idit
a d o talit . Despite a tifu gal the ap al-
so o talit a ges f o - % i fe as-
es [ , ].
I a othe ise i u o o pete t pe -
so , Aspergillus o idia a e i haled a d take
up phago tes i the lu gs. The o idia
ge i ate i to h phae at od te pe atu e.
I i u o o pete t hosts, phago tes se-
ete ediato s hi h a ti ate eut ophils.
Neut ophils kill the i asi e h phae, a d the
Aspergillus i fe tio is kept at a . If a of
these e ha is s a e i pai ed i a i u -
o o p o ised patie t, the i fe tio a e
allo ed to sp ead.
A st o g li i al suspi io to ide tif pa-
tie ts at isk fo i asi e aspe gillosis is the
fi st step i e aluati g fo aspe gillosis. The
fu gal i os op of the sputu should e
do e fi st to ide tif a patie t ith i asi e
aspe gillosis sho s a gula di hoto ousl
a hi g septate h phae i IA . I o al
hosts the e e p ese e of Aspergillus does
ot e essa il i di ate a ute i fe tio , ho -
e e , i the i u o o p o ised host, fi d-
i g the fu gus should p o pt the li i ia to
t eat as a a ute i fe tio . The ultu e of
the Aspergillus spe ies i the sputu o
o hoal eola la age ith the ide tifi a-
tio of h phae, hi h is the gold sta da d,
ill o fi that the i fe tio is
f o Aspergillus a d ot a othe ould o
fu gus. Tissue iops of a aspe gillo a a e
helpful to o fi the diag osis a d e lude oth-
e o ditio s that a ause lu g asses.
Se u io a ke s su h as gala to a a
assa s a e helpful; it a also e easu ed i
sa ple f o a o hoal eola la age. Test
should e used as a s ee i g tool fo the ea l
dete tio of IA. Si gle o o se uti e positi e as-
sa s se u ith high OD i de a se e as a
i o iologi al ite io fo p o a le IA. Gala -
to a a f o BAL fluid - de o st ated e el-
le t se siti it i hae atolog a d o -
hae atolog patie ts ,solid o ga t a spla t e-
ipie ts, i te si e a e u it patie ts, patie ts
ith auto-i u e diso de s, AIDS patie ts, used
as a o fi ato diag osti assa i patie ts
ith u e plai ed adiologi al featu es. It’s ot
suita le fo the ea l dete tio of IA ho e e
BAL GM assa s et e e o e ded to assess
the out o e of a tifu gal the apies.
Chest adiog aphs a sho pa e h al
opa ities of pul o a aspe gillo a fu gus
all . CT i agi g of the lu gs ill sho ha a te -
isti odules ith su ou di g atte uatio halo
sig , aspe gillo a fu gal all i a p e-e isti g
lu g a it , a itatio s, o fi osis. Blood ul-
tu es i su h ases a e of li ited alue, ofte ot
positi e e e i disse i ated i fe tio . The p es-
e e of , - eta D-glu a s i se u sig ifies
the p ese e of fu gal i asio ut is ot spe ifi
fo Aspe gillus spe ies. PCR- ased diag osis ha e
ot ee sta da dized a d e ai i estigatio -
al.
20
Ou patie t as i espi ato dist ess &
o ECMO. Chest a as sho i g ilate al
opa ities i oth lo e lo es, oth se u
a d BAL gala to a a e e positi e, fu -
gus i os op KOH as positi e fo a ute
a gle a hed fu gal h phae. A o di g to
EORTC/MSG Eu opea o ga izatio fo e-
sea h a d t eat e t of a e /M osis
stud g oup ; it as fulfilli g the ite ia of
P o a le I asi e Aspe gillosis so o i o a-
zole as sta ted i ediatel fo the patie t.
Vo i o azole is fo ulated as sulfo ut l-
ethe lode t i solutio fo IV ad i ist a-
tio a d lode t i ole ule is e all
lea ed so a u ulatio of the ehi le o u s
i i di iduals ith e al i suffi ie [ ].
This d ug is hepati all eta olized, ith
o l % of the d ug appea i g u ha ged i
the u i e. Si e i ou patie t oth se u
eati i e a d se u ili u i sta ted to ise,
o eo e li i al p og essio as e poo
so o i o azole as kept o hold, a phote i-
i B alo g ith a idulafu gi as sta ted.
U fo tu atel patie t also de eloped g a
egati e sepsis, as o i t a e ous olisti
fo the sa e ut e pi ed o th da of ad-
issio . Cause of death as att i uted to
i asi e aspe gillosis, ARDS , g a egati e
sepsis o ILD ith ulti o ga failu e.
Co lusio : Patie ts u de goi g ECMO a e at
i eased isk of i fe tio s o pa ed to oth-
e patie ts i ICU. Cli i ia s should o side
i fe tio ith fu gus i patie t ot espo d-
i g to a ti ioti s. ECMO patie ts ith IPA did ot
al a s ha e lassi u de l i g isk fa to s[ ]. Di-
ag osi g IPA i ICU patie ts a e diffi ult ut a
li i al algo ith to diag ose IPA i su h patie ts
a e useful thoughts should ot e gi e fo
usi g o i atio a tifu gal the ap . Cli i ia s
should also o ito o i o azole le el i the se-
u to guide dosi g a d to a oid a tifu gal i -
te a tio a d side effe ts.
Refere es
. Mosie JM, Kelse M, Raz Y,Gu e so KJ,
Me e R,H pes CD. E t a o po eal e -
a e o ge atio ECMO fo iti all ill
adults i the e e ge depa t e t: histo ,
u e t appli atio s, a d futu e di e tio s.
C it a e ; :
. Pa ell BJ, Ku a P, Raju BC, Joh so EM,
Fa do TC, Ol e WJ. I asi e pul o a as-
pe gillosis post e t a o po eal e a e
o ge atio suppo t a d lite atu e. Med -
ol ase ep ; : -
. Ca a as YA, Yusuff H, Po te R. Fu gal i fe -
tio s i adult patie ts o e t a o po eal life
suppo t. C it Ca e. Ap ; :
. A eele AM, Bulpa P, Misset B, Messe a
W,Ca doso T, Pai a JA.Epide iolog of i a-
si e aspe gillosis i iti all ill patie ts: li i-
al p ese tatio , u de l i g o ditio s, a d
out o es C it Ca e ; :
21
. Au o C, Che g AC, Pi he D, Leo g T,
Meg i G, Coope DJ et al. I fe tio s a
ui ed adults ho e ei e e t a o po-
eal e a e o ge atio : isk fa to s
a d out o e. I fe t Co t ol Hosp Epi-
de iol ; : – .
. Hsu MS, Chiu KM, Hua g YT, Kao KL, Chu
SH, Liao CH. Risk fa to s fo oso o ial
i fe tio du i g e t a o po eal e -
a e o ge atio .J Hosp I fe t ;
: – .
. Ma as o SF, Lukas G, M Do ald M,
M Milla J, Ihle B .Re ie of ECMO e t a
o po eal e a e o ge atio sup-
po t i iti all ill adult patie ts. Hea t
Lu g Ci ; : – .
. Ale izakos M, Fa akiotis D, M lo akis E. Up-
dated p a ti e guideli es fo the diag osis
a d a age e t of aspe gillosis: halle ges
a d oppo tu ities. J Tho a Dis. De ;
: - .
. Segal BH. Aspe gillosis. N. E gl. J. Med.
Ap ; : - .
. Kise TH, Fish DN, A uila te CL, Ro e
JE, We pe MF, Ma La e R E aluatio of sul-
fo ut lethe -β- lode t i SBECD a u u-
latio a d o i o azole pha a oki eti s i
iti all ill patie ts u de goi g o ti uous
e al epla e e t the ap . C it Ca e.
Fe ; : .
22
I trodu tio
B east i fla atio i o e of ep odu -
ti e age g oup is see o e o o l i la -
tati g as o pa ed to o -la tati g o e .
A ute i fla atio of east a e att i ut-
ed to the i eased a ti it of the east tis-
sue i espo se to fe ale ho o es. I fe -
ti e auses of east a s ess i lude Staph -
lo o us aureus ith the p edo i a t patho-
ge i pli ated i oth the g oups. Whilst,
Kle siella p eu o iae, Peptostrepto o us
ag us, Strepto o us group B, E tero a ter
loa ae, Methi illi resista t staph lo o us
aureus MRSA a d M o a teriu tu er u-
losis e e espo si le fo east a s esses
o l i o la tati g o e .
B east a s ess due to Sal o ella i fe tio is
a e, though fe ases ha e ee epo ted
f o I dia. - Sal o ella i fe tio s a e a a-
jo pu li health p o le i I dia a d a e
t a s itted o all o ta i ated food a d
ate . I t a ellula su i al st ategies afte
phago tosis help these a te ia to disse i ate
th oughout the od a d lo alize i the eti ulo-
e dothelial s ste . Sal o ellosis a li i all
a ifest as e te i fe e , food poiso i g septi-
ae ia ith o ithout lo al suppu ati e lesio .
It has ee i pli ated i e do a ditis, osteo e-
litis, is a iage, , e i gitis, a s ess fo -
atio i li e , pa eas, gall ladde a d
splee .
He e e p ese t a ase of east a s ess due to
Sal o ella ithout a k o p edisposi g fa -
to s.
Case Report
A ea s old ou g lad p ese ted ith a pai -
ful lu p i ight east. She had fe e o a d off
fo - da s ith episodes of dia hoea
a ou d the sa e ti e hi h as self esol i g.
This patie t as a k o ase of h poth oidis
ith a past histo of t o fi st t i este a o -
tio s. She had a ea s old ale hild ho as
ot east-fed. He last p eg a as u e-
A ase epo t of isdiag osed east a s ess
Autho s: D Pu a i Ba a , D Ta u Thuk al , D Shi pi Chop a , D Sa deep Na a
Depa t e t: Depa t e t of Cli i al Mi o iolog a d Depa t e t of Respi ato Medi i e,
I stitute: BLK Supe Spe ialit Hospital, Ne Delhi.
Co espo di g autho : pu a i. a a @g ail. o
Case report
23
ful e ept fo the histo of gestatio al dia-
etes. She also de ied a histo of gall
sto es.
The patie t had take edi al opi io f o a
lo al p a titio e a d as put o a ti-
i fla ato edi atio alo g ith a o i-
illi - la ula i a id as a e pi i al a ti i-
oti . The eafte a ult asou d as pe fo ed
that e ealed a ell defi ed o al h po e hoi
lesio of . i uppe i e uad a t. A
ildl e la ged ode ith thi ke ed o te
as see i the ight a illa. C tolog of the
east lesio e ealed g a ulo atous asti-
tis. Based o the fi di gs of i agi g esults
she as e pi i all sta ted o a titu e ula
the ap ATT .
No , the patie t p ese ted seeki g a se o d
opi io to us. O lo al e a i atio , the a ea
as a ith ild te de ess i the uppe
i e uad a t of ight east. A s all o ile
lu p ould e eli ited o adhe e t to the
ski . The patie t as afe ile ith a pulse
ate of pe i ute. No othe a o alit
as dete ted o s ste i e a i atio .
The a s ess as d ai ed ult asou d guid-
ed aspi atio a d sa ple as o tai ed fo
i o iologi al e aluatio to ule out a
i fe ti e patholog . Stai i g fo a id fast a-
illi, Ge e pe t a d M o a te iu ultu e
e e egati e. Di e t G a ’s stai sho ed
ple t of leu o tes ut o a te ia e e
see . Blood, u i e a d stool ultu es e e o
o t i uto a d Widal test as o ea ti e.
Ae o i ultu e of the a s ess g e Sal o ella
Parat phi A hi h as esista t to Nalidi i a id
ith i te ediate sus epti ilit to ip oflo a i .
It as sus epti le to A pi illi , azith o i ,
efi i e, eft ia o e, hlo a phe i ol a d o-
t i o azole. The patie t as put o i t a e ous
eft ia o e g a hou l fo da s. The e-
afte , she as put o o al efi i e g t i e
dail fo a othe da s. The e as a sig ifi a t
espo se to t eat e t. The lu p su sided a d
patie t e o e ed o pletel .
Dis ussio
Sal o ella T phi a d Parat phi A a e espo si le
fo o idit a d o talit espe iall i de elop-
i g ou t ies. The li i al spe t u of sal o el-
losis is a ied a d a p ese t i the fo of gas-
t o-i testi al i fe tio , a te ae ia, fo al dis-
ease o a lead to a a ie state. E t a-
i testi al fo al a ifestatio s a e a ied a d
depe d o fa to s like e t e es of age, i u e-
supp essio , i t a- e ous d ug a use, p e ious
t au a et .
B east a s ess as a a ifestatio of Sal o ella
i fe tio is a a e o ditio . Repo ts of Sal o el-
la Pa at phi A h o i east a s ess i I dia
ha e ee epo ted f o M so e a d Pu e. I
the a se e of a sig ifi a t past histo of
24
fe e , gast o-i testi al i fe tio othe tha
t o self li iti g episodes of dia hoea o
t au a, the sou e of i fe tio i the p ese t
ase still e ai s dou tful. Although lood,
stool a d u i e sa ples o tai ed f o the
patie t did ot ield Sal o ella, the p o a-
ilit of the patie t ei g a a ie a ot e
uled out. I a o la tati g fe ale, seedi g
of Sal o ella i the east tissue th ough a
a ie state, although u likel , is the o l
p o a ilit o side ed the autho s.
To su a ize, this ase highlights the fa t
that Sal o ella a p ese t ith at pi al
li i al pi tu es a d ust e o side ed as a
diffe e tial diag osis i su h situatio s.
The use of ATT is a pa t i ou ou t . As
see i this ase, ithout a o lusi e e i-
de e, the patie t as sta ted o ATT. Thus
it is i pe ati e to state that li i al judge-
e t alo g ith a o ust i o iologi al
suppo t is helpful to li h the diag osis a d
i stitute app op iate t eat e t.
Refe e es:
. A delHadi MSA, Bukha ie HA. B east i -
fe tio s i o -la tati g o e . J Fa il
Co u it Med Sep-De ; :
- .
. Ja aku a K, Appala aju B, Go i da VK.
A at pi al p ese tatio of Sal o ella
T phi- a ase epo t. I dia J Med Mi o iol
; : - .
. Siddesh G, Su a a MN. A ase of east a -
s ess due to Sal o ella Pa at phi A. I t J
Health Allied S i ; : - .
. Ghadage DP, Wa khade AB, Mali RJ, Bho e
AV. Re u e t east a s ess due to Sal o-
ella Pa at phi A: a u usual ase. I t J Res
Med S i Aug; : - .
. Lesse CF, Mille SI. Sal o ellosis. I : B au -
ald E, Fau i AS, Kaspe DL, Hause SL, Lo go
DL, Ja eso JL, edito s. Ha iso ’s p i iples
of i te al edi i e. th ed. Ne Yo k NY :
M G a Hill; . p. - .
. Kau R, Ba a P. A ase of Sal o ella t phi
i fe tio leadi g to is a iage. J La Ph si-
ia s Ja -Ju ; : - .
. Je a PP, Duggal SD, Ku a A, Bha a a T, Sha -
a A, Gu R. Isolatio of Sal o ella t phi
f o agi al s a i a ase of septi a o -
tio . I dia J Med Mi o iol Ap -Ju ;
: - .
. Va ai a A, Sa as athi K, Te dolka U, De A,
Shah S, Mathu M. Sal o ella e te itidis
e i gitis- A ase epo t. I dia J Med Mi-
o iol ; : - .
. A a M, A a PK. Pa eati a s ess aused
S. T phi. I dia J Med Mi o iol ;
: - .
. Si ha S, Sha a DC, Mi i B, Gupta V, Chatto-
padh a TK. Sple i a s ess- ase epo t a d
e ie of lite atu e. T op Gast oe te ol
Jul-Sept; : - .
25
Microbiology Updates from around the world….
Mi ro iolog Update :
WHO re o e ds t phoid o jugate a i e i e de i setti gs
The Wo ld Health O ga izatio WHO e o -e ds i ple e tatio of atio al t phoid a -
i atio p og a s as pa t of oade o t ol effo ts i setti gs he e t phoid is e de i . I Ma h , the WHO i di ated a p efe e e fo t phoid o jugate a i e TCV o e othe t phoid a i es a d e o e ded TCV ad i -ist atio fo hild e si o ths o olde , ith at h-up a i atio a paig s fo hild e up
to ea s old.
Co pa ed ith othe t phoid a i es, TCV has g eate a d lo ge lasti g i u oge i it a d has esta lished safet i i fa ts a d ou g hil-d e . A TCV li e sed i I dia a d Nepal is u de -goi g li e su e i othe e de i ou t ies; TCV is ot a aila le i the U ited States o Eu ope.
Refe e e: Wo ld Health O ga izatio . T phoid a i es: WHO positio pape . Ma h . http://apps. ho.i t/i is/ itst ea /ha dle/ / /WER .pdf
Mi ro iolog Update :
La ge out eak of liste iosis i South Af i a
Liste iosis is a food o e a te ial ill ess that auses i asi e i fe tio s, p i a il i i di iduals ith a p edisposi g fa to , su h as p eg a o i -u osupp essio . The la gest liste iosis out eak
dete ted to date ega i South Af i a i Ja ua , ith o e tha la o ato - o fi ed as-
es epo ted as of id-Ma h .
The likel sou e of the out eak, a ead -to-eat p o essed eat p odu t alled polo , as ide ti-fied th ough hole ge o e se ue i g. Re alls
e e su se ue tl issued i South Af i a a d othe Af i a ou t ies to hi h the p odu t as dist i uted
Refe e e:
Liste iosis – South Af i a A aila le at http://. ho.i t/ s /do / - a h- -liste iosis-
south-af i a/e /
Mi ro iolog Update :
O al fe al i o iota t a spla tatio fo e u e t C. diffi ile i fe tio Fe al i o iota t a spla tatio FMT deli e ed ia olo os op is esou e-i te si e a d i asi e. I a
o i fe io it t ial, patie ts ith e u e t Clost idiu diffi ile i fe tio CDI e e a do l as-sig ed to FMT ad i iste ed ia o al apsules o olo os op . At eeks, pe e t i oth g oups
e e f ee of CDI e u e e. Fe al i o ial di e sit ates i eased a d e e ai tai ed fo up to eeks follo i g FMT i oth
g oups. While o al apsules appea to e a ia le deli e ethod fo FMT, thei li i al a aila ilit is li ited, a d thei ost-effe ti e ess is still to e dete i ed.
Refe e e: Kao D, Roa h B, Sil a M, et al. Effe t of O al Capsule- s Colo os op -Deli e ed Fe alMi o iota T a spla tatio o Re u e t Clost idiu diffi ile I fe tio : A Ra do ized Cli i al T ial. JAMA ;
:
26
Microbiology Updates from around the world….
Mi ro iolog Update :
ART i itiatio o da of HIV diag osis i e-sou e-li ited setti gs
The Wo ld Health O ga izatio WHO e o -e ds i itiatio of a ti et o i al the ap ART ithi the fi st se e da s of a HIV diag osis.
I itiatio of a ti et o i al the ap ART ea l i the ou se of HIV i fe tio athe tha aiti g fo CD ell de li e edu es se e e AIDS a d
o -AIDS ill esses.
Se e al t ials i esou e-li ited setti gs ha e de o st ated the e efit of ART at p og essi e-l highe CD ell ou ts. , , Ne e theless, the opti al st ateg fo i ple e tatio e ai s u e tai .
I a t ial i Lesotho, ART i itiatio at ho e o the da of diag osis i p o ed su se ue t li k-age to a e e sus pe e t a d i ologi supp essio e sus pe e t o pa ed
ith outi e health fa ilit efe al fo ART i iti-atio .
Ho e e , those ates e e still u a epta l lo , a d a t ial patie ts e pe ie ed
t eat e t i te uptio , putti g the at isk fo d ug- esista t HIV. Fu the stud is a a ted to ide tif su essful
app oa hes, hi h a diffe lo atio , pa-tie t populatio , a d ART egi e utilized.
Refe e es: . A a i e G, Se itala FC, Na uso a J, et al.
Effe ts of a ulti o po e t i te e tio to st ea li e i itiatio of a ti et o i al the ap i Af i a: a stepped- edge luste - a do ised t ial. La et HIV ; :e .
. Rose S, Maske M, Fo MP, et al. I itiati g A -ti et o i al The ap fo HIV at a Patie t's Fi st Cli i Visit: The RapIT Ra do ized Co t olled T ial. PLoS Med ; :e .
. La ha dt ND, Ri ge a I, Lejo e TI, et al. Effe t of Offe i g Sa e-Da ART s Usual Health Fa ilit Refe al Du i g Ho e-Based HIV Testi g o Li kage to Ca e a d Vi al Supp essio A o g Adults With HIV i Lesotho: The CASCADE Ra -do ized Cli i al T ial. JAMA ; : .
. Walke AS, P e de gast AJ, Mug e i P, et al. Mo talit i the ea follo i g a ti et o i al the ap i itiatio i HIV-i fe ted adults a d hil-d e i Uga da a d Zi a e. Cli I fe t Dis
; : .
Mi ro iolog Update :
Nipah i us out eak i I dia
I Ma , a out eak of Nipah i us as epo ted i I dia's Ke ala state, a d at least people died. Most ases o u ed i fa il e e s o health a e o ke s a i g fo i fe ted patie ts, ho had high fe e , o iti g, a d eathi g diffi ulties. T a s issio a e at-to-hu a th ough di e t o -ta t o a i te ediate a i al host o hu a -to-hu a . The e is o esta lished t eat e t fo Nipah
i us; thus, edu atio a d app op iate i fe tio o t ol p e autio s e ai ke to p e e ti g sp ead of i fe tio
Refe e e: Chatte jee P. Nipah i us out eak i I dia. La et ; : .
27
Microbiology Updates from around the world….
Mi ro iolog Update :
Me ope e - a o a ta i o pli ated u i-a t a t i fe tio
Me ope e - a o a ta is a o el a ti ioti o i atio of a a ape e ith a oad-
spe t u eta-la ta ase i hi ito that pote tl i hi its e tai a ape e ases.
Va o a ta is a o el oad-spe t u eta-
la ta ase i hi ito that pote tl i hi its lass A a ape e ases i ludi g K. p eu o iae-a ape e ases [KPC] . It is ot a ti e agai st lass B o D a ape e ases ie, etallo- eta-
la ta ases a d OXA-t pe e z es . The additio of a o a ta to e ope e
edu es the MICs to e ope e a o g lass A a ape e ase-p odu i g E te o a te ia eae to ild-t pe MIC le els.
Me ope e - a o a ta as o pa a le to pipe a illi -tazo a ta i a t ial of patie ts
ith o pli ated u i a t a t i fe tio a d it is ei g e aluated i patie ts ith a te e ia,
hospital-a ui ed p eu o ia, a d o pli ated i t aa do i al i fe tio s. The ai ole of this age t is fo t eat e t of KPC-p odu i g E te o-
a e ia eae ut it does ot e ha e the li i al a ti it of e ope e agai st a ape e -
esista t P. ae ugi osa o A i eto a te spp. Data e aluati g out o es ith su h o ga is s a e li ited ut e e gi g.
Refe e e: 1. Lo o ska a O, Su D, Ru io-Apa i io D, et al.
Va o a ta : Spe t u of Beta-La ta ase I hi-itio a d I pa t of Resista e Me ha is s o
A ti it i E te o a te ia eae. A ti i o Age ts Che othe ; .
. Casta hei a M, Hu a d MD, Me des RE, Fla RK. Me ope e -Va o a ta Tested agai st
Co te po a G a -Negati e Isolates Colle ted Wo ld ide du i g , I ludi g Ca ape e -
Resista t, KPC-P odu i g, Multid ug-Resista t, a d E te si el D ug-Resista t E te o a te i a eae. A ti i o Age ts Che othe ; .
Mi ro iolog Update :
Mo e e ide e fo o t o e sial theo that He pes i uses pla ole i Alzhei e 's disease
The uest to u de sta d hat auses Alzhei-e 's disease -- a d to t eat it -- is o pli ated the disease's lo g, slo p og essio a d the
diffi ult of olle ti g ai tissue sa ples. But i a la ge-s ale a al sis pu lished Ju e , i the jou al Neu o , esea he s at the I ah S hool of Medi i e at Mou t Si ai use data f o th ee diffe e t ai a ks to suggest that hu a he pes i uses a e o e a u da t i the
ai s of Alzhei e 's patie ts a d a pla a ole i egulato ge eti et o ks that a e e-
lie ed to lead to the disease. Also, esea he s at the I stitute of Hu a Be-
ha iou a d Allied S ie es ide tified eight a -didate ge es elated to o idati e st ess/i fla atio as pote tial AD isk a ke s ith pote tial i ol e e t i i al pathoge esis. These o ks suppo ts the o t o e sial h poth-esis that i uses a e i ol ed i Alzhei e 's dis-ease a d offe s pote tial e paths fo t eat-
e t. Refe e e: Be Readhead, Jea -Via e Hau e-Mi a de, et al.
Multis ale A al sis of I depe de t Alzhei e ’s Co-ho ts Fi ds Dis uptio of Mole ula , Ge eti , a d Cli i al Net o ks Hu a He pes i us. Neu o ,
; DOI: . /j. eu o . . .
Tal a Pu eet, Gupta Re u, etal. Elu idati g ole of o idati e st ess a d i fla ato a ke s i Alzhei-
e ’s disease usi g s ste s iolog app oa h. Doi: . / X
28
Microbiology Crossword 02
Clues
Answers: Next Jeevanu times
29
OFFICIAL PUBLICATION OF IAMM DC