Publications by authors named "Jagdish Chander"

142 Publications

Aspergillus candidus eumycetoma with review of literature.

J Mycol Med 2021 Apr 3;31(3):101135. Epub 2021 Apr 3.

Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, India.

Objective: Mycetoma is a slowly progressive, chronic granulomatous infection of skin and subcutaneous tissues with involvement of underlying fasciae and bones, usually affecting extremities. In India, among mycetoma, the eumycetoma constitutes about 35% of cases. Hereby, we report the first case of eumycetoma caused by uncommon fungus, Aspergillus candidus.

Case Report: A 61 year old female presented to the Department of Dermatology with history of swelling of right foot associated with multiple firm nodules of approx. 1.5 × 1.5 cm each over dorsum of foot with discharging sinus containing white color granules. Biopsy of lesion on right foot on direct KOH examination revealed septate hyphae. Histopathology examination showed a histiocytic granuloma with fungal elements. Culture on Sabouraud Dextrose Agar grew white mycelial colonies which were identified to be Aspergillus species phenotypically. Genetic sequencing using Internal transcribed spacer gene, beta tubulin gene and Calmodulin gene was done and the isolate was identified to be Aspergillus candidus. Lesion was excised and patient was started on itraconazole.

Conclusion: Timely identification and starting of antifungal treatment can help in reducing morbidity due to eumycetoma to a large extent. As newer and newer species of fungi are emerging as significant causative agents of human infections, it is pertinent to report such findings from epidemiological point of view.
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http://dx.doi.org/10.1016/j.mycmed.2021.101135DOI Listing
April 2021

Serratia no longer an opportunistic uncommon pathogen - case series & review of literature.

Infect Disord Drug Targets 2021 Feb 22. Epub 2021 Feb 22.

Department of Microbiology, Government Medical College Hospital, Chandigarh. India.

Background: Serratia spp. is a common enteric bacterium generally thought not to be pathogenic in the gastrointestinal tract. Serratia marcescens is a member of the genus Serratia, which is a part of the family Enterobacteriales..Of all Serratia species, S. marcescens is the most common clinical isolate and the most important human pathogen.

Objective: We are discussing here four cases of Serratia marcescens which we reported in our laboratory in the Department of Microbiology Government Medical College and Hospital Chandigarh during six months of duration.

Method: All the samples were processed and identified as per standard microbiological techniques.The isolates of Serratia marcescens were identified, depending upon their biochemical and morphological characters and further confirmed by MALDI-TOF-MS ,PGIMER Chandigarh.

Result: In one of the four cases there was polymicrobial infection and one patient was diabetic and rest three patients were immunocompetent. The importance of detection and reporting of Serratia marcescens is related to the concern regarding its increase spread in hospital settings as nosocomial infection .

Conclusion: We need to identify and isolate this pathogen ,not thinking of only contaminant and opportunistic pathogen but as a pathogen which can lead to serious infections in hospital settings .
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http://dx.doi.org/10.2174/1871526521666210222125215DOI Listing
February 2021

Quinolone Susceptibility in Isolates Based on Minimum Inhibitory Concentration Determination.

J Lab Physicians 2020 Dec 30;12(4):263-267. Epub 2020 Dec 30.

Department of Microbiology, Government Medical College and Hospital, Chandigarh, India.

Typhoid fever, caused by and , is a generalized infection with case fatality of about 10%. The symptoms may be severe, with life threatening sequelae of infection in a proportion of cases. Antimicrobial agents are the mainstay of therapy in enteric fever so as to prevent the complications associated with severe illness and mortality in the patients. Fluoroquinolones (e.g., ciprofloxacin) are very effective against completely susceptible bacteria. However, their efficacy is doubtful once any resistance is detected. Pefloxacin testing has ultimately helped in the accurate identification of quinolone susceptibility for a better therapeutic success rate. In the present study we have tried to evaluate the quinolone susceptibility in isolates based on minimum inhibitory concentration (MIC) determination.  The method used in the study is quinolone susceptibility in isolates based on MIC determination. isolates show intermediate susceptibility to ciprofloxacin using disk diffusion. Both ciprofloxacin and pefloxacin MIC evaluation has been done to corroborate the results with pefloxacin disk diffusion testing. There was a positive correlation between the susceptibility to ciprofloxacin and pefloxacin. However, the isolates with intermediate susceptibility had variations in terms of susceptibility to pefloxacin. MIC values for pefloxacin and our findings suggested that pefloxacin susceptible on disk diffusion as per Clinical and Laboratory Standards Institute guidelines showed lower values for MIC using Pefloxacin HICOMB test and pefloxacin resistant isolates showed higher MIC values.
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http://dx.doi.org/10.1055/s-0040-1721163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773437PMC
December 2020

Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India.

Trop Doct 2021 Apr 29;51(2):162-167. Epub 2020 Dec 29.

Professor and Head, Department of Microbiology, Government Medical College Hospital, Chandigarh.

The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.
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http://dx.doi.org/10.1177/0049475520982457DOI Listing
April 2021

Fournier's gangrene due to Salmonella Typhimurium in a healthy male: a rare aberrant infection.

Infect Disord Drug Targets 2020 Nov 17. Epub 2020 Nov 17.

Department of Microbiology, Government Medical College and Hospital, Chandigarh sector 32. India.

Introduction: Human Salmonella infections have been classically distinguised into diseases caused by typhoidal and non-typhoidal salmonella (NTS). Typhiodal salmonella includes S. enterica serovars Typhi and Paratyphi that cause the systemic disease but are restricted to human infections, while NTS consists mainly of other serovars that predominantly cause self-limiting gastroenteritis in humans. Localisation of foci with persisting infection occurs due to dissemination of the bacteria throughout the body and can cause a variety of rare clinical syndromes at aberrant sites. Fournier's gangrene, a rapidly progressive, often fatal, necrotizing fasciitis of the external genitalia and perineum due to Salmonella Typhimurium, is a rare manifestation and has never been reported.

Case: A 22-year-old male, apparently healthy patient with no relevant past medical history presented to surgical emergency with chief complaints of swelling of bilateral scrotal area. Infective etiology was considered and a diagnosis of fournier's gangrene was made. Pure growth of Salmonella Typhimurium was obtained after repeated subculture and was identified biochemically and on serotyping, as Salmonella enterica serotype Typhimurium using specific antisera.

Conclusion: In our case report, we describe a case of fournier's gangrene due to Salmonella Typhimurium in an otherwise healthy male to highlight the unusual presentation of Non typhoidal salmonellae at an aberrant site. We also emphasize the importance of using selective media like Selenite F broth for isolation of Salmonella Typhimurium from a pus sample.
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http://dx.doi.org/10.2174/1871526520666201117143421DOI Listing
November 2020

Detection of various beta-Lactamases in and sp.: A study from Tertiary Care Centre of North India.

Indian J Med Microbiol 2020 Jul-Dec;38(3 & 4):390-396

Department of Microbiology, Government Medical College and Hospital, Chandigarh, India.

Objective: The emergence of carbapenem-resistant Escherichia coli and Klebsiella species is a global threat. We aimed to compare two phenotypic methods and evaluate the genotypic method for the detection of beta-lactamases produced by E. coli and Klebsiella spp.

Materials And Methods: One hundred and twenty-six E. coli and Klebsiella isolates were examined for phenotypic production of beta-lactamases by using disc diffusion, combined disc test (CDT) and modified carbapenem inactivation method (mCIM). All strains were also studied for the presence of various genes by polymerase chain reaction.

Results: Out of 126 isolates, 96% of the isolates were extended-spectrum β-lactamase (ESBL) producers based on the presence of various ESBL genes. CDT method showed higher number of total (89%) carbapenemases in comparison to mCIM (81%). Among carbapenemases none of the isolates were Klebsiella pneumoniae carbapenemase producer by CDT, while 69% isolates were metallo-beta-lactamase (MBL) producers. Another method, mCIM/ethylene diamine tetraacetic acid mCIM showed 100% agreement for MBL detection. As regards, AmpC and class D carbapenemases; 0.04% and 16% positivity was detected, respectively, based on CDT method. Molecular analysis revealed 91% of the isolates harbouring carbapenemase genes. blawas the most common gene detected followed bybla. Nine of the bla-positive isolates also possessed blagene.

Conclusion: Our finding shows high percentages of ESBL and carbapenemases in E. coli and Klebsiella spp. Among phenotypic methods, CDT seems to be a better choice as prevalence of carbapenemases shows lots of variation in our country. For Class B enzymes, both CDT and mCIM/eCIM can be used in the routine laboratories.
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http://dx.doi.org/10.4103/ijmm.IJMM_20_253DOI Listing
November 2020

Identification and Sensitivity of Vaginal and Probiotic species to Urinary Antibiotics.

J Lab Physicians 2020 Aug 2;12(2):111-114. Epub 2020 Sep 2.

Department of Microbiology, Government Medical College and Hospital, Chandigarh, India.

 Healthy vaginal microbiota is mainly dominated by species namely , , , and . Lactobacilli are thought to play an important role in the prevention of urogenital infections, and probiotics to restore and/or maintain vaginal health has been advocated. These can interfere with the adherence, growth, and colonization by uropathogenic bacteria, thus reducing the risk of urinary tract infection (UTI). This study aims to isolate and evaluate the susceptibility of healthy vaginal and probiotic spp. to urinary antibiotics.  A total of 50 premenopausal, nonmenstruating women with no symptoms of vaginal infection or UTI or antimicrobial use in the past 2 weeks were enrolled. Two high vaginal swabs were collected for Nugent's scoring and anaerobic culture. Colonies yielding gram-positive rods were confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). strains in a vaginal probiotic tablet were also isolated, and the sensitivity of both sets to urinary antibiotics was determined.  A total of 29 spp. were isolated, including (15), (5), (4), (2), (1), (1), and (1). All strains were susceptible to nitrofurantoin and resistant to norfloxacin, gentamicin, and cotrimoxazole (except ). The probiotic strains were pan-sensitive.  Prophylactic antibiotics are capable of eliminating the normal vaginal inhabitants, which may increase the probability of UTI. The administration of vaginal probiotics as an alternate or multidrug therapy can restore vaginal microbiota and help prevent recurrent UTI.
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http://dx.doi.org/10.1055/s-0040-1716604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467827PMC
August 2020

Needles in a haystack: Extremely rare invasive fungal infections reported in FungiScope-Global Registry for Emerging Fungal Infections.

J Infect 2020 11 13;81(5):802-815. Epub 2020 Aug 13.

Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.

Objectives: Emerging invasive fungal infections (IFI) have become a notable challenge. Apart from the more frequently described fusariosis, lomentosporiosis, mucormycosis, scedosporiosis, and certain dematiaceae or yeasts, little is known about extremely rare IFI.

Methods: Extremely rare IFI collected in the FungiScope registry were grouped as Dematiaceae, Hypocreales, Saccharomycetales, Eurotiales, Dermatomycetes, Agaricales, and Mucorales.

Results: Between 2003 and June 2019, 186 extremely rare IFI were documented in FungiScope. Dematiaceae (35.5%), Hypocreales (23.1%), Mucorales (11.8%), and Saccharomycetales (11.3%) caused most IFI. Most patients had an underlying malignancy (38.7%) with acute leukemia accounting for 50% of cancers. Dissemination was observed in 26.9% of the patients. Complete or partial clinical response rate was 68.3%, being highest in Eurotiales (82.4%) and in Agaricales (80.0%). Overall mortality rate was 29.3%, ranging from 11.8% in Eurotiales to 50.0% in Mucorales.

Conclusions: Physicians are confronted with a complex variety of fungal pathogens, for which treatment recommendations are lacking and successful outcome might be incidental. Through an international consortium of physicians and scientists, these cases of extremely rare IFI can be collected to further investigate their epidemiology and eventually identify effective treatment regimens.
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http://dx.doi.org/10.1016/j.jinf.2020.08.015DOI Listing
November 2020

An experience with Delamanid in an XDR TB case - Case report.

Infect Disord Drug Targets 2020 Jul 19. Epub 2020 Jul 19.

Department of Microbiology,Government Medical College Hospital-32, Sector 32, Chandigarh. India.

Introduction: Tuberculosis is an endemic infection and a serious public health problem in India. India constitutes one fourth of the global TB population. The emerging drug resistance is a major threat to global tuberculosis care and control.

Case Report: We present an experience with a case of newly diagnosed microbiologically confirmed, extremely drug resistant primary pulmonary tuberculosis who was treated with delamanid and found to be cured of tuberculosis.

Discussion: Delamanid is a new anti-tubercular drug, which is thought to primarily inhibit synthesis of methoxy-mycolic, and keto-mycolic acid, which are components of the mycobacterial cell wall. In our patient who was a newly diagnosed case of MDR-TB converted to XDR-TB in course of time and we were successful in treating him with delamanid therapy. His sputum culture conversion was achieved in 20 days. Even though the patient did not tolerate well because of the side effects of the drug, still he became microbiologically negative for tuberculosis.

Conclusion: Delamanid fulfills many target criteria for new TB drugs and may be particularly useful for the treatment of MDR-TB. It can be administered orally and its bactericidal properties make it suitable in regimens designed to shorten treatment duration. Clinical efficacy data, while limited, are reassuring.
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http://dx.doi.org/10.2174/1871526520666200720113711DOI Listing
July 2020

Characteristics, outcome and risk factors for mortality of paediatric patients with ICU-acquired candidemia in India: A multicentre prospective study.

Mycoses 2020 Jul 17. Epub 2020 Jul 17.

Nizam's Institute of Medical Sciences, Hyderabad, India.

Background: The epidemiology, clinical profile and outcome of paediatric candidemia vary considerably by age, healthcare settings and prevalent Candida species. Despite these differences, few comprehensive studies are undertaken. This nationwide study addresses this knowledge gap.

Methods: 487 children who contracted ICU-acquired candidemia at 23 Indian tertiary care centres were assessed for 398 variables spanning demography, clinical characteristics, microbiology, treatment and outcome.

Results: Both neonates (5.0 days; range = 3.0-9.5) and non-neonatal children (7.0 days; range = 3.0-13.0) developed candidemia early after ICU admission. Majority of neonates were premature (63.7%) with low birthweight (57.1%). Perinatal asphyxia (7.3%), pneumonia (8.2%), congenital heart disease (8.4%) and invasive procedures were common comorbidities, and antibiotic use (94.1%) was widespread. C tropicalis (24.7%) and C albicans (20.7%) dominated both age groups. Antifungal treatment (66.5%) and removal of central catheters (44.8%) lagged behind. Overall resistance was low; however, emergence of resistant C krusei and C auris needs attention. The 30-day crude mortality was 27.8% (neonates) and 29.4% (non-neonates). Logistic regression identified admission to public sector ICUs (OR = 5.64), mechanical ventilation (OR = 2.82), corticosteroid therapy (OR = 8.89) and antifungal therapy (OR = 0.22) as independent predictors of 30-day crude mortality in neonates. Similarly, admission to public sector ICUs (OR = 3.62), mechanical ventilation (OR = 3.13), exposure to carbapenems (OR = 2.18) and azole antifungal therapy (OR = 0.48) were independent predictors for non-neonates.

Conclusions: Our findings reveal a distinct epidemiology, including early infection with a different spectrum of Candida species, calling for appropriate intervention strategies to reduce candidemia morbidity and mortality. Independent factors identified in our regression models can help tackle these challenges.
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http://dx.doi.org/10.1111/myc.13145DOI Listing
July 2020

Changing Clinicoradiologic Spectrum of Intracranial Neurotuberculosis in Children: A Cross-sectional Study.

J Child Neurol 2020 11 17;35(13):879-888. Epub 2020 Jul 17.

Department of Pediatrics, 29746Government Medical College and Hospital, Chandigarh, India.

Background: Neurotuberculosis is among the most severe type of tuberculosis with high mortality and morbidity in all age groups. Various sociodemographic and disease-/treatment-related factors have emerged over the years that can affect clinical and radiologic features of neurotuberculosis.

Objective: To investigate various clinical and neuroradiologic presentations of neurotuberculosis.

Methodology: This cross-sectional study was done in a tertiary care center of northern India. The patients between the ages of 3 months and 18 years with newly diagnosed neurotuberculosis were enrolled after taking informed consent.

Results: A total of 78 patients (37% males) were enrolled. Fifty-six patients (72%) had tubercular meningitis (TBM) and 22 (28%) isolated tuberculomas. Very high percentage of patients in both the groups was BCG vaccinated. In the tubercular meningitis group, fever (68%), headache (59%), and vomiting (54%) were the most common complaints whereas in the tuberculoma group, seizures (95.5%) were the main complaint and systemic symptoms were rare. In tubercular meningitis patients, cerebrospinal fluid-based studies showed cartridge-based nucleic acid amplification test (Xpert MTB/RIF) positivity for in 17.6% cases, whereas on gastric aspirate and sputum examination, acid-fast bacilli were seen in 30.7% and cartridge-based nucleic acid amplification test was positive in 19% patients. On neuroimaging, hydrocephalus was seen in 44.6% of tubercular meningitis patients, infarcts in 32%, and basal exudates in 12% patients only; coexistent tuberculomas were seen in 53%.

Conclusion: Compared with the available literature, the present study showed a smaller percentage of children <5 years of age, stage III tubercular meningitis cases, and typical neuroradiologic findings like hydrocephalus and basal exudates and more tuberculomas associated with tubercular meningitis.
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http://dx.doi.org/10.1177/0883073820938594DOI Listing
November 2020

Characterization of Bacteriological Isolates from Patients and Environment Samples of Burn Ward: A Study from a Tertiary Care Hospital of India.

Infect Disord Drug Targets 2021 ;21(2):238-242

Department of Microbiology, Government Medical College Hospital, Chandigarh, India.

Objective: Source of infection in a burn patient is from the patient's flora, contaminated environmental surfaces and transmitted from health care workers. Insufficiently disinfected hospital environmental surface provides a niche for multidrug resistant bacteria. This study was carried out to assess the bacteriological profile of the pathogens from burn wounds and the surrounding environmental areas.

Methods: During 6 months, wound swabs from burn patients were collected on admission (after 48 hours of admission), on day 5 and then weekly. Environmental samples were also collected from burn ward and studied for the bacteriological and anti-microgram profiles.

Results: Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii were the major bacterial isolates from the wound swabs and the environmental samples. ESBL was detected in 56.6% of our Enterobacteriaceae isolates. The environmental sites from which these bacterial isolates were found were nursing counter, sink, dressing trolley, medicine locker and patient's bed. The percentage of MRSA decreased from 50 to 5% and there was an increased role of Enterococci species causing infections (13.63%).

Conclusion: In this study, there appears that the colonizers of the environment may play a role in the causation of infection in burn patients. In burns ward, rigorous implementation of infection control program should be warranted, which includes and hygiene and use of personal protective equipment, environmental disinfection, cohort nursing care and antibiotics stewardship programme.
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http://dx.doi.org/10.2174/1871526520666200609120659DOI Listing
January 2021

Nocardia Infections: Ten Years Experience from a Tertiary Health Care Center in North India (2007-2016).

Infect Disord Drug Targets 2021 ;21(3):445-451

Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, India.

Background: Nocardia species are important cause of infections in humans but are underreported due to missed diagnosis as well as misdiagnosis. Majority of the literature on these infections consists of case reports or series with few articles describing high number of cases.

Objective: To study the epidemiology of Nocardia infections in a tertiary care center.

Materials And Methods: This retrospective observational study was done in a tertiary care centre of North India over a period of 10 years (2007-2016). The detection of Nocardia spp. from clinical specimens was done by conventional methods viz. direct microscopy (Gram's stain, modified Ziehl -Neelsen stain [1%], KOH examination) and culture.

Results: A total of 25 cases of nocardiosis were diagnosed during the study period. The mean age of the patients was 50.9 years (range 30-72 years) with a male:female ratio of 3:2. The site of disease in these patients included pulmonary (n=18), cutaneous (n=4), perinephric abscess (n=1), ocular (n=1) and bone (n=1). Risk factors associated were underlying lung disease (n=11), smoking (n=7), diabetes (n=5) and steroid therapy (n=4) in pulmonary nocardiosis, iatrogenic (n=1) and leprosy (n=1) in cutaneous nocardiosis, diabetes in perinephric abscess and cataract surgery in ocular nocardiosis. Culture was positive in 12/25 (48%) patients for Nocardia spp. Direct microscopy was positive in 22 patients. We wish to highlight that meticulous observation of KOH wet mount examination helped in clinching the diagnosis of Nocardiosis in 3 cases which were earlier missed by other methods.

Conclusion: Good communication with the clinician alongside a meticulous effort in the laboratory is essential for appropriate diagnosis and management of these cases.
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http://dx.doi.org/10.2174/1871526520666200516161940DOI Listing
January 2021

Clinicoepidemiological and Genotyping Correlation of Pediatric Scrub Typhus from Chandigarh, India.

Indian Pediatr 2020 04;57(4):314-316

Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India.

Objective: We studied the clinical phenotypes and prevalent genotypes of Orientia tsutsugamushi in our area using indirect immunofluorescence assay (IFA).

Methods: We prospectively screened all febrile children presenting to our hospital over three years. From among children who were scrub typhus positive by ELISA we selected a sample of convenience for IFA testing to determine the genotypes of O. tsutsugamushi using four strains namely Boryong, Gilliam, Karp and Kato.

Results: Of all scrub positive patients (n=77), we tested 14 samples using IFA and all 14 samples were IFA positive. Karp genotype (n=7) was most prevalent followed by Kato (3), Boryong (1) and Gilliam (1) genotypes; 2 patients were positive for mixed genotype. There was high prevalence of organ dysfunction among IFA positive children. Three most common organ dysfunctions included hematological derangement in all, liver involvement in 10 (71%), and encephalopathy and shock in 4 each.

Conclusions: Karp was the most prevalent genotype of O. tsutsugamushi in our area.
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April 2020

Phaeohyphomycosis: Cytomorphologic Evaluation in Eleven Cases.

Acta Cytol 2020 23;64(5):406-412. Epub 2020 Mar 23.

Government Medical College and Hospital, Chandigarh, India.

Objective: Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide which causes a wide variety of clinical manifestations.

Study Design: A retrospective analysis of 11 cases diagnosed with fungal inflammation on cytology over a period of 6 years (2013-2018) was done along with culture/histopathologic confirmation.

Results: Of the total of 11 cases, 9 cases presented with subcutaneous swellings and 1 case each with brain and lung lesions. The age range was 30-83 years (mean: 53.6); 8 patients were male and 3 were female. Cytologic smears showed fungal profiles with septate tortuous hyphae, as well as swollen and narrow, yeast-like swellings with an irregular breadth of the hyphae in all cases. The fungal profiles were visualized on a Masson-Fontana stain. The background showed inflammatory cells, giant cells, and necrosis in variable proportions. Five cases were diagnosed as phaeohyphomycosis on cytology, whereas 3 cases were misdiagnosed as aspergillus and 2 as candida. In 1 case, typing of the fungus was not done. Histopathology was available in 5 cases, and in all these a diagnosis of phaeohyphomycosis was reached. Ten of the 11 cases had confirmation on fungal culture.

Conclusions: Phaeoid fungi are rarely seen in routine cytologic practice. Careful evaluation of cytologic smears and an awareness of the characteristic morphologic features of phaeohyphomycosis are helpful in arriving at a correct diagnosis. Fine needle aspiration cytology provides a rapid diagnosis, enabling prompt therapy.
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http://dx.doi.org/10.1159/000506432DOI Listing
September 2020

Molecular identification of species complex isolated from clinical samples and its antifungal susceptibility patterns.

Curr Med Mycol 2019 ;5(4):43-49

Department of Microbiology, Government Medical College Hospital, Chandigarh, India.

Background And Purpose: More than 300 species are grouped into approximately 23 species complexes out of which around 70 are involved in human infections. The nomenclature of these species has undergone considerable changes in recent years. These species cause localized infections in individuals while inducing systemic infections mainly in immunocompromised patients. The present study was conducted to identify species in clinical isolates by molecular methods and determine their in vitro minimum inhibitory concentration (MIC) patterns to address the lack of data in this domain in Northern India.

Materials And Methods: For the purpose of the study, isolates obtained from various clinical samples were sent to the Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands, for molecular identification. The MIC testing was performed using the microbroth dilution method as per the Clinical and Laboratory Standards Institute reference method (M38-A2).

Results: was isolated from 33 patients (i.e., 1, 1, 2, 14, and 15 cases with endophthalmitis, sinusitis, pulmonary involvement, onychomycosis, and keratitis, respectively). These 33 isolates belonged to three species complexes, namely species complex (FSSC; n=13), species complex (FFSC; n=13), and species complex (FIESC; n=7). The species identified within FSSC, FFSC, and FIESC included (n=6)/ (n=6)/ (n=1), (n=7)/ (n=5)/ (n=1), and SC species (n=6)/ SC species (n=1), respectively. The MIC results showed that all isolates had a lower MIC against amphotericin B than against the other antifungal agents.
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http://dx.doi.org/10.18502/cmm.5.4.2149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034782PMC
January 2019

Corynebacterium Striatum, an Emerging Nosocomial Pathogen: Case Reports.

Infect Disord Drug Targets 2021 ;21(2):301-303

Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh, India.

Background: Corynebacterium striatum is an emerging nosocomial pathogen, capable of causing a variety of infections in immunocompromised and hospitalized patients. ; Case Presentation: We describe three cases of infection by C. striatum that were initially considered as contamination. Clinical suspicion in the wake of predisposing factors and accurate identification, using the Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS), were key to implicate this commensal bacterium as a cause of infection.
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http://dx.doi.org/10.2174/1871526520666200224103405DOI Listing
January 2021

Isolation of and Species from Clinical Samples in a Tertiary Care Hospital in North India.

Infect Disord Drug Targets 2021 ;21(1):84-89

Department of Microbiology, Government Medical College Hospital, Chandigarh, India.

Introduction: The members of the tribe Proteeae, Morganella and Providencia are being increasingly recognized as important pathogens. The spectrum of disease caused by them is wide and in reported cases, the mortality is high. Previously both of these pathogens were considered to be rare pathogens as the potential to cause nosocomial transmission and infection was not much studied. But their phenomenal evolution and increase in multidrug-resistance (MDR) strains of these pathogens are posing a major threat toward public health throughout the world.

Methods: This present study was carried out from July 2018 to December 2018 on all the pus and body fluid samples that were received in the Department of Microbiology. Samples were processed as per the standard Microbiological guidelines and also were analyzed for their antimicrobial susceptibility profile as per Clinical Laboratory Standards Institute.

Results: Out of 8425 samples received, 2140 were culture positive, amongst which 19 samples (0.89%) were positive for Providencia species (9) and Morganella morganii(10). The male : female ratio of these 19 patients was 2.8 : 1 and maximum patients (13) belonged to 20-60 years. As far as risk factors are concerned, maximum patients were diabetics (7) followed by abnormal liver function tests (6), concomitant UTI (6), history of invasive procedure (5), prior exposure to antibiotics (5) and urinary catheterization (4). About 6 were polymicrobial infections. Antibiotic susceptibility patterns revealed that Providencia strains were sensitive to ampicillin- sulbactum (77.7%) and amikacin (77.7%), while all Morganella strains were 100% sensitive to tobramycin and piperacillintazobactam.

Conclusion: This study heralds in need for more research in this area as infections caused by these two pathogens are on the rise. Moreover, resistance to antimicrobials is also an increasingly common problem thus delaying the treatment and prognosis of the disease.
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http://dx.doi.org/10.2174/1871526520666200128162646DOI Listing
January 2021

Bacteriological Profile in Attico-antral type of Chronic Suppurative Otitis Media.

Indian J Otolaryngol Head Neck Surg 2019 Nov 4;71(Suppl 2):1412-1421. Epub 2018 Sep 4.

1Department of ENT, Govt Medical College and Hospital, Sector-32, Chandigarh, India.

Chronic suppurative otitis media is defined as a chronic inflammation of the middle ear cleft, which presents with recurrent ear discharge through a tympanic membrane perforation. The purpose of this study was to find pattern of bacteriology in patients of atticoantral type of chronic suppurative otitis media as it will help the clinician to decide the effective antibiotics to be prescribed. This prospective and observational study was conducted in the Department of ENT in collaboration with Department of Microbiology, Government Medical College and Hospital, Chandigarh. The ear discharge specimen of all patients meeting the inclusion criteria were collected and sent for microbial examination. Culture positive samples were subjected to antibiotic sensitivity. A total of one hundred ears (mean age 27.33 years) clinically diagnosed with chronic suppurative otitis media, atticoantral type were included in this study based on the preset inclusion and exclusion. The male: female ratio in our patients was 0.94:1. Ninety-seven (96.9%) patients had unilateral disease, while 3 (3.1%) patients had bilateral disease. Twenty-eight percent of the total samples were sterile. The most common bacteria isolated were (27.1%), Methicillin sensitive (23.3%) and (6.5%). was sensitive to polymyxin B (100%) followed by ciprofloxacin (46.4%), neomycin (42.9%) and gentamicin (42.9%). Polymyxin B is the most effective antibiotic against the cultured bacteria followed by gentamicin, ciprofloxacin and neomycin.
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http://dx.doi.org/10.1007/s12070-018-1486-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841772PMC
November 2019

Risk factors and antimicrobial susceptibility pattern in patients with culture-positive typhoid.

Natl Med J India 2018 Nov-Dec;31(6):380

Department of Microbiology, Government Medical College and Hospital, Sector 32, Chandigarh, India.

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http://dx.doi.org/10.4103/0970-258X.262899DOI Listing
October 2019

Linezolid Resistance in Staphylococcus haemolyticus - Case Series and Review of Literature.

Infect Disord Drug Targets 2020 ;20(5):713-717

Govt. Medical College and Hospital Microbiology, Chandigarh, India.

Background: Coagulase negative Staphylococci (CoNS) are important. The common antibiotics used for the treatment of the infections caused by CoNS are penicillin, oxacillin, ciprofloxacin, clindamycin, erythromycin, gentamicin, and vancomycin. Linezolid is an oxazolidinone group of antibiotic with activity against Gram-positive bacteria. It is used for the treatment of serious infections caused by Gram-positive bacteria resistant to other antibiotics, including streptococci, vancomycin-resistant enterococci (VRE).

Aims And Objective: This study emphasizes on the judicious use of newer antibiotics to contain the spread of resistance.

Method: We are discussing five cases of Linezolid resistant Staphylococcus Haemolyticus which were reported in our laboratory during one year from patients with device related infections and also review of literature is being presented for an update.

Result: In our study, the isolates were resistant to other groups of antimicrobials but susceptible to glycopeptides. All the isolates were methicillin-resistant.

Conclusion: Linezolid is approved as an alternative drug to be given for catheter-related bloodstream infections. In earlier studies, linezolid-resistant staphylococci have been reported increasingly all over the world. This study is to create awareness amongst clinicians that improper and excessive use of linezolid will make this antibiotic-resistant and thus will be of no help in future, so judicious and relevant use of antibiotics needs to be emphasized.
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http://dx.doi.org/10.2174/1871526519666190807152850DOI Listing
May 2021

Biofilms: Fungal perspective.

Indian J Pathol Microbiol 2019 Jul-Sep;62(3):514-515

Department of Microbiology, Government Medical College Hospital, Chandigarh, India.

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http://dx.doi.org/10.4103/IJPM.IJPM_20_18DOI Listing
December 2019

Submandibular Lymphadenitis in an Immunocompetent Female: Microbiological Confirmation is Need of the Hour.

Infect Disord Drug Targets 2020 ;20(6):929-931

Department of Microbiology, Government Medical College and Hospital, Sector- 32, Chandigarh, India.

Background: Non-tuberculous mycobacterial (NTM) infections have been drawing interest recently because of their rising incidence not only in immunocompromised but also in immunocompetent individuals. These are underdiagnosed in India, due to the lack of awareness and a low index of suspicion. In regions endemic for tuberculosis (TB) such as India, presumptive anti-tubercular treatment (ATT) is often prescribed. Non-response of NTM to the treatment may be wrongly ascribed to multidrug-resistant tuberculosis. This emphasizes the need to correctly identify them before initiating therapy.

Case Study: We describe the case of a young, healthy female patient who developed cervical lymphadenitis and was given presumptive ATT. Microbiological examination of aspirate revealed M. fortuitum. This not only rectified the course of treatment resulting in complete cure, but also spared the patient from significant side effects of ATT. This case is an awakening call for clinicians to avoid presumptive ATT.
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http://dx.doi.org/10.2174/1871526519666190619150549DOI Listing
January 2020

Vancomycin-resistant enterococci & healthcare-associated risk factors in paediatric intensive care unit.

Indian J Med Res 2019 01;149(1):71-73

Department of Microbiology, Government Medical College Hospital, Chandigarh 160 030, India.

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http://dx.doi.org/10.4103/ijmr.IJMR_2063_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6507533PMC
January 2019

Evaluation of efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis.

J Dermatolog Treat 2020 Nov 16;31(7):749-753. Epub 2019 May 16.

Department of Microbiology, Government Medical College and Hospital, Chandigarh, India.

There has been an alarming increase in recalcitrant dermatophytosis in recent years. The standard treatment guidelines no longer seem effective in achieving clearance and results in high failure rates. To evaluate the efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis. Clinically diagnosed and KOH positive patients of tinea corporis/cruris/faciei were randomly divided into three groups and given terbinafine 250 mg, itraconazole 200 mg and a combination of both once daily taken on the same day respectively for 3 weeks. Partial responders at the end of the therapy were given same treatment for additional 3 weeks. Clinical parameters namely itching, erythema, and scaling were evaluated at baseline, 3, 6, and 9 weeks. Adverse effects were noted at the end of therapy. Maximum clinical and mycological cure was achieved in group III (receiving combination therapy) (90%) followed by group II (receiving itraconazole) (50%) and group I (receiving terbinafine) (35%). The combination therapy of oral terbinafine and itraconazole was found to be as safe as monotherapy without any significant adverse effects. The combination of systemic terbinafine and itraconazole therapy may be an effective and safe therapeutic strategy in the management of dermatophytosis.
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http://dx.doi.org/10.1080/09546634.2019.1612835DOI Listing
November 2020

Evaluation of various risk factors associated with multidrug-resistant organisms isolated from diabetic foot ulcer patients.

J Lab Physicians 2019 Jan-Mar;11(1):58-62

Department of Surgery, Government Medical College and Hospital, Chandigarh, India.

Aims: Diabetic foot ulcer is a dreaded complication of diabetes. Diabetic foot ulcer patients are often infected with multidrug resistant organism (MDRO) due to chronic course of the wound, inappropriate antibiotics treatment, frequent hospital admission, neuropathy, nephropathy, and peripheral vascular disease.

Materials And Methods: This prospective study was conducted in our 750 bedded hospital for a period of 6 months. The present study was undertaken to isolate various MDRO methicillin resistant ; Gram-negative bacteria producing enzymes such as extended spectrum beta-lactamases (ESBL), Amp C, Carbapenamases; and species producing metallo-beta-lactamases (MBL). In addition we attempted to identify risk factors for association of diabetic foot ulcer and MDRO.

Results: A total of 149 bacterial isolates were identified. Of the total isolates 73.2% were Gram-negative and remaining 26.8% were Gram-positive bacteria. Among 59% were ESBL producers and 48% were Amp C producers. In addition, 41.5% of the isolates produced both ESBL and Amp C and 13.4% were carbapenem resistant . Among 20 and isolates, 5 were MBL producers (25%). Furthermore, in the study, 56% of patients with diabetic foot ulcer harbored MDRO. The risk of multidrug-resistant infection is significantly more in patients having diabetes duration >20 years and size of ulcer more than 4 cm.

Conclusion: The detection of MDRO in patients of diabetic foot ulcer changes the treatment strategies limits the antimicrobial options and causes higher complications among them.
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http://dx.doi.org/10.4103/JLP.JLP_106_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437817PMC
April 2019

Post-Traumatic Endophthalmitis Due to Acinetobacter radioresistens: Virulence Potential of Commensal Bacteria.

Infect Disord Drug Targets 2020 ;20(4):556-558

Government Medical College and Hospital, Sector 32, Chandigarh, India.

Acinetobacter species are widely distributed in soil, water and hospital environment. In addition to A. calcoaceticus-baumannii complex, the clinically most relevant species, there are other genomospecies which are less frequently identified, mostly due to lack of accurate methods for routine identification. We describe the first case of post-traumatic endophthalmitis caused by otherwise non-pathogenic A. radioresistens, in India. Gram-negative coccobacilli were observed on Gram stain and culture of vitreous fluid specimen, and identified biochemically as Acinetobacter spp. The species was identified by Matrix Assisted Laser Desorption Ionization- Time of Flight Mass Spectrometry (MALDI-TOF MS). The pathogenic potential of 'commensal' A. radioresistens and its role in dissemination of carbapenem resistance genes underlines the importance of species-level identification in Acinetobacter infections.
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http://dx.doi.org/10.2174/1871526519666190123145321DOI Listing
May 2021

Prognostic factors in 264 adults with invasive Scedosporium spp. and Lomentospora prolificans infection reported in the literature and FungiScope.

Crit Rev Microbiol 2019 Feb 10;45(1):1-21. Epub 2019 Jan 10.

a Department I of Internal Medicine , University Hospital of Cologne , Cologne , Germany.

Invasive Scedosporium spp. and Lomentospora prolificans infections are an emerging threat in immunocompromised and occasionally in healthy hosts. Scedosporium spp. is intrinsically resistant to most, L. prolificans to all the antifungal drugs currently approved, raising concerns about appropriate treatment decisions. High mortality rates of up to 90% underline the need for comprehensive diagnostic workup and even more for new, effective antifungal drugs to improve patient outcome. For a comprehensive analysis, we identified cases of severe Scedosporium spp. and L. prolificans infections from the literature diagnosed in 2000 or later and the FungiScope registry. For 208 Scedosporium spp. infections solid organ transplantation (n = 58, 27.9%) and for 56 L. prolificans infection underlying malignancy (n = 28, 50.0%) were the most prevalent risk factors. L. prolificans infections frequently presented as fungemia (n = 26, 46.4% versus n = 12, 5.8% for Scedosporium spp.). Malignancy, fungemia, CNS and lung involvement predicted worse outcome for scedosporiosis and lomentosporiosis. Patients treated with voriconazole had a better overall outcome in both groups compared to treatment with amphotericin B formulations. This review discusses the epidemiology, prognostic factors, pathogen susceptibility to approved and investigational antifungals, and treatment strategies of severe infections caused by Scedosporium spp. and L. prolificans.
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http://dx.doi.org/10.1080/1040841X.2018.1514366DOI Listing
February 2019

Characterization and antimicrobial susceptibility of coagulase-negative staphylococci isolated from clinical samples.

J Lab Physicians 2018 Oct-Dec;10(4):414-419

Department of Microbiology, Government Medical College and Hospital, Chandigarh, India.

Purpose: This study has been done to speciate coagulase-negative staphylococci (CoNS) and also study their antibiotic susceptibility pattern isolated from clinical samples.

Materials And Methods: A total of 120 consecutive CoNS were isolated from various clinical samples such as blood, pus, wound swab, drain fluid, tracheal aspirate, peritoneal fluid, and pleural fluid over a period of 6 months. CoNS were identified by characteristic growth on media such as Blood agar and MacConkey agar. Speciation and identification were done by a range of biochemical testing such as PYR broth hydrolysis, novobiocin resistance, polymyxin B sensitivity, and then by matrix-assisted laser desorption ionization-time of flight. Antibiotic susceptibility of the isolates was done by Kirby-Bauer disk diffusion method as per CLSI 2017 guidelines.

Results: Among the 120 isolates, the most common species was (56.67%) followed by (21.67%), (11.67%), (5%), (3.33%), and finally (1.67%). Good susceptibility was noted toward linezolid (100%), vancomycin (100%), teicoplanin (100%), and doxycycline (80.2%). The antibiotics to which resistance was seen were penicillin (96.5%), ciprofloxacin (57.1%), and oxacillin (45.5%). MR CoNS in our study ranged from 50% to 68.67%.

Conclusion: Antibiotic resistance in CoNS is increasing toward penicillin, ciprofloxacin, and oxacillin as found in our study. The antibiotics such as vancomycin, teicoplanin, linezolid, and doxycycline which showed good susceptibility, therefore, should be kept as reserve drugs and used judiciously.
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http://dx.doi.org/10.4103/JLP.JLP_55_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210844PMC
December 2018