Diagnostic performance of oral swabs for non-sputum based TB diagnosis in a TB/HIV endemic setting

Objective We evaluated diagnostic performance of oral swab analysis (OSA) for tuberculosis (TB) in a high HIV/TB burden setting in Kenya. Methods In this cross-sectional study, buccal swabs and sputum were collected from 100 participants with suspected TB in outpatient clinics in Kenya at enrollment and subsequent morning visits. Buccal swabs underwent IS6110-targeted qPCR analysis. Sputum was evaluated by Xpert MTB/RIF (Xpert) and culture. Diagnostic performance of OSA for TB diagnosis was evaluated relative to a combined reference of sputum Xpert and culture. Results Among 100 participants, 54% were living with HIV (PLHIV). Twenty percent (20/100) of participants had confirmed TB (19/20 [95%] culture-positive, 17/20 [85%] Xpert-positive). Overall buccal swab sensitivity was 65.0% (95% CI 40.8–84.6%) vs. sputum Xpert/culture and 76.5% (95% CI 50.1–93.2%) vs. sputum Xpert alone. Specificity was 81.3% (95% CI 71.0–89.1%) and 81.9% (95% CI 72.0–89.5%) compared to sputum Xpert/culture and Xpert alone, respectively. Sensitivity among PLHIV (n = 54) with suspected TB was 83.3% (95% CI 35.9–99.6%) vs. sputum Xpert/culture and 100% (95% CI 47.8–100.0%) vs. sputum Xpert alone. Among participants with TB, mean OSA threshold quantitation cycle (Cq) value was lower (stronger signal) at subsequent morning compared to enrolment visit (33.4 SD ± 3.7 vs. 35.2 SD ± 2.9, p = 0.009). Conclusions In this pilot study, results confirm M. tuberculosis DNA is detectable in oral swabs including among PLHIV with fair diagnostic performance. Further work is needed to optimize OSA and evaluate its utility in diverse settings.

Microbiological pathogen analysis in native versus periprosthetic joint infections: a retrospective study

Background The presence or absence of an implant has a major impact on the type of joint infection therapy. Thus, the aim of this study was the examination of potential differences in the spectrum of pathogens in patients with periprosthetic joint infections (PJI) as compared to patients with native joint infections (NJI). Methods In this retrospective study, we evaluated culture-positive synovial fluid samples of 192 consecutive patients obtained from January 2018 to January 2020 in a tertiary care university hospital. For metrically distributed parameters, Mann–Whitney U was used for comparison between groups. In case of nominal data, crosstabs and Chi-squared tests were implemented. Results Overall, 132 patients suffered from periprosthetic joint infections and 60 patients had infections of native joints. The most commonly isolated bacteria were coagulase-negative Staphylococci (CNS, 28%), followed by Staphylococcus aureus (S. aureus, 26.7%), and other bacteria, such as Streptococci (26.3%). We observed a significant dependence between the types of bacteria and the presence of a joint replacement (p < 0.05). Accordingly, detections of CNS occurred 2.5-fold more frequently in prosthetic as compared to native joint infections (33.9% vs. 13.4% p < 0.05). In contrast, S. aureus was observed 3.2-fold more often in NJIs as compared to PJIs (52.2% vs. 16.4%, p < 0.05). Conclusion The pathogen spectra of periprosthetic and native joint infections differ considerably. However, CNS and S. aureus are the predominant microorganisms in both, PJIs and NJIs, which may guide antimicrobial therapy until microbiologic specification of the causative pathogen.

Clinical and Microbiological Characteristics of Culture-Positive, Influenza-Associated Pulmonary Aspergillosis: A Single-Center Study in Southern Taiwan, 2016–2019

This study delineated the characteristics of 24 (11.2%) culture-positive, influenza-associated pulmonary aspergillosis (IAPA) patients out of 215 patients with severe influenza during 2016–2019 in a medical center in southern Taiwan. Twenty (83.3%) patients did not have EORTC/MSG-defined host factors. The mean time from influenza diagnosis to Aspergillus growth was 4.4 days, and 20 (83.3%) developed IAPA within seven days after influenza diagnosis. All patients were treated in intensive care units and all but one (95.8%) received mechanical ventilation. Aspergillus tracheobronchitis was evident in 6 (31.6%) of 19 patients undergoing bronchoscopy. Positive galactomannan testing of either serum or bronchoalveolar lavage was noted in all patients. On computed tomography imaging, IAPA was characterized by peribronchial infiltrates, multiple nodules, and cavities superimposed on ground-glass opacities. Pure Aspergillus growth without bacterial co-isolation in culture was found in 17 (70.8%) patients. A. fumigatus (15, 62.5%), A. flavus (6, 25.0%), and A. terreus (4, 16.7%) were the major causative species. Three patients had mixed Aspergillus infections due to two species, and two had mixed azole-susceptible and azole-resistant A. fumigatus infection. All patients received voriconazole with an all-cause mortality of 41.6%. Of 14 survivors, the mean duration of antifungal use was 40.5 days. In conclusion, IAPA is an early and rapidly deteriorating complication following influenza that necessitates clinical vigilance and prompt diagnostic workup.

Comparison Between Culture-Positive and Culture-Negative Septic Shock in Emergency Department Patients

Culture results in patients with septic shock affect their management strategies. Our study aimed to compare the clinical characteristics and outcomes of patients with culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS). A single-center, retrospective, case-control study included adult patients diagnosed with septic shock in the emergency department between January 1, 2019 and March 31, 2020. They were divided into CNSS and CPSS groups based on their culture results. Patients with CPSS (63.7%, 311/488) and CNSS (36.3%, 177/488) were identified. The CPSS and CNSS groups had comparable clinical outcomes, including mechanical ventilation (29.6% vs. 32.8%, p = 0.46), renal replacement therapy (19.3% vs. 23.2%, p = 0.31), intensive care unit care (51.8% vs. 45.2%, p = 0.16), 30-day (35.7% vs. 36.7%, p = 0.82) and in-hospital mortality (39.5% vs. 41.8%, p = 0.63). The duration (13 [8−19] vs. 16 [10−23], days, p = 0.04) and de-escalation timing (5 [2−10] vs. 9 [7−12], day, p = 0.02) of antibiotic administration in the CNSS group was significantly shorter and earlier than in the CPSS group. Patients with CNSS and CPSS had similar clinical characteristics and adverse outcome proportions. Physicians can evaluate the feasibility of early de-escalation or discontinuation of antibiotic administration in CNSS patients with clinical improvement.

Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital

Background: Typhoid fever is a severe debilitating and potentially life threating illness. In Bangladesh, typhoid fever is a round the year problem which sometimes take epidemic proportions. The reasons behind such occurrences are unsafe water supply, defective sewage system and unhygienic food handling practice. This study aimed to compare the efficacy of ceftriaxone and azithromycin in the treatment of uncomplicated enteric fever.Methods: An observational study was conducted at the department of pharmacology in Dhaka medical college, Dhaka, Bangladesh. Data were collected from blood culture positive patients for Salmonella typhi and Salmonella paratyphi, who admitted in the Dhaka medical college and hospital, Dhaka during the period of July 2015 to June 2016. Data was collected by using a structured questioner, face to face interview, physical examination and investigation reports. Patients were hospitalized during the entire treatment period and at admission evaluation was made by history and physical examination in a structured format. Subjects ware asked regarding changes in symptoms and possible adverse effects of the study drugs. All patients were asked to return two weeks after completion of treatment for follow up. Blood culture of Salmonella typhi or Salmonella paratyphi were done in all cases. Total 91 patients were culture positive for either S. typhi or S. paratyphi which were finally studied.Results: During the study period out of 91 patients, 51 were receiving ceftriaxone and 40 were receiving azithromycin. Clinical cure was achieved in 46 patients (90%) of ceftriaxone group and in 31 patients (78%) in the azithromycin group. There were no significant differences of clinical cure between both treatment groups (p>0.05). Mean fever clearance time in ceftriaxone group was 3±1.4 days and was 4±1.6 days for azithromycin group. Difference in fever clearance time was statistically significant (p<0.05). No clinical relapses were detected in any study subject. No major side effects of both drugs occurred in any subject.Conclusions: These results indicated that both ceftriaxone and azithromycin were effective against enteric fever caused by sensitive organisms and multi drug resistant S. typhi and S. paratyphi. It is concluded that ceftriaxone is more effective and can be a convenient alternative for the treatment of enteric fever, especially in developing countries like us where medical resources are scarce.

Spectrum of dermatophytes in a tertiary care centre in Northern India

Dermatophytes is major public health challenge in many parts of the world, mainly in developing countries due to poor housing facilities, high population per capita, and poor sanitary conditions. Early diagnosis and identification is must for preventing and early treatment of dermatophytosis. Also, some studies suggest that in prepubescent children there is an inadequate amount of fungi inhibiting fatty acids synthesized predisposing them to dermatophytic infections. Reduction in the synthesis of these fungistatic triglycerides in sebum premenopausal women is also seen predisposing them to infection by dermatophytes. However, low socioeconomic status along with illiteracy and overpopulation has been a main predisposing factor to dermatophytic infections in developing parts of the world. The incidence also been increased due to the rise in the number of immunocompromised patients and considerable use of broad-spectrum antibioticsEarly finding of infection is must for prevention and early management of dermatophytosis. Dermatophytes enter keratinized tissue via keratinases, which produce a dermal inflammatory response causing burning, itching and rednessTo determine prevalence of species of dermatophytes. This Study was conducted on 334 samples i.e. skin scrapings, nail clippings, and hair for fungal culture in the Mycology laboratory over a period of one year extending from December 2019 to December 2020. Specimens were cultured on modified Sabouraud's dextrose agar media containing antibiotics and incubated at 25°C and 37°C for a period of 4 weeks. Isolation and identification of various species of dermatophytes were done. A cross-sectional study was conducted on patients who came to our hospital in the department of dermatology or were referred to the department of microbiology over a period of one year extending from November 2019 to November 2020. Microbiological tests of suspected patients included potassium hydroxide (KOH) mount and fungal culture examination. Cases with culture-positive results were correlated with clinical diagnosis. In the study total of 334 samples (skin scrapings, nail clippings, and hair) were received for fungal culture in the microbiology laboratory during the study period. Samples obtained were cultured on modified Sabouraud's dextrose agar (SDA) media containing antibiotics and incubated at 25°C and 37°C for a period of 4 weeks. Species identification was performed based on colony's morphology, finding of the teased mount by using lactophenol cotton blue stain (LCB) and slide culture, and also with urea hydrolysis test as seen.The Study was performed on 334 samples received from the department of dermatology for fungal culture. Fungal elements were seen in 31% of cases and were isolated in 30% of cases. In these culture-positive cases, dermatophytes were reported in 90% cases, Candida species in 4%, and another fungus was reported in 6% cases. Trichophyton species is most commonly isolated (27.6%). Microsporum and Epidermophyton species were isolated in 5.1% cases. T. mentagrophytes was the most common fungal isolate among all the culture-positive cases.

Bacteriological profile and the sensitivity patterns of culture positive organisms in COVID-19 positive patients

Use of antibiotics without proper confirmation carries risk of over use of antibiotics. It is associated with certain side effects like loss of natural bacterial flora present in the human body. It can lead to resistance to the bacteria due to irrational use of antibiotics. Present study was carried out to study the bacteriological profile and the sensitivity patterns of culture positive organisms in COVID-19 positive patients.Hospital based cross-sectional study was carried out from March 2021 to June 2021 in the Department of Microbiology, Malla Reddy Institute of Medical Sciences (MRIMS), Hyderabad in 38 samples. These samples were referred from General Medicine Department. Culture and sensitivity was done in all cases. Majority of subjects belonged to the age group of 20-29 years (31.6%). The proportion of males (57.9%) was more than the proportion of females (42.1%). Most common co-morbidity was diabetes seen in 21.1% of the cases. was the most common organism found in four cases. Incidence of secondary bacterial infection in COVID-19 patients in the present study was 39.5%. Among the antibiotics studied in COVID-19 patients, amikacin, ciprofloxacin, imipenem, piperacillin-tazobactum, nitrofurantoin and chloramphenicol were found to be highly sensitive to most of the organisms. Antibiotics like cefepime, ampicillin, ceftazidime and cotrimoxazole were resistant to most of the organisms.Based on the study findings, we conclude that antibiotics like amikacin, ciprofloxacin, imipenem, piperacillin-tazobactum, nitrofurantoin and chloramphenicol can be used in most of the patients with COVID-19.Antibiotics should be used with caution especially in patients with COVID-19. Antibiotics like amikacin, ciprofloxacin, imipenem, piperacillin-tazobactum, nitrofurantoin and chloramphenicol can be used in most of the patients with COVID-19 while awaiting the results of culture and sensitivity. In all cases where physicians are in dilemma culture and sensitivity is highly recommended.

Re-decontamination of liquid mycobacterial cultures: Additional Mycobacterium tuberculosis yield in the era of Xpert MTB/RIF Ultra in Cape Town, South Africa

A retrospective review of liquid mycobacterial cultures was performed at a laboratory in South Africa from 01 January 2018 to 31 December 2018 to assess the increased yield in detecting Mycobacterium tuberculosis complex following sample re-decontamination. Only 9 of 99 (9%) re-decontaminated samples were culture positive for M. tuberculosis complex. Xpert MTB/RIF Ultra, concurrently performed on 7 of the 9 samples, detected M. tuberculosis complex in all but 1 sample. Re-decontamination of non-sterile samples did not increase the M. tuberculosis complex yield enough to offset the financial costs and additional labour in a laboratory that utilises the Xpert MTB/RIF Ultra system as a first-line diagnostic modality.